Healthcare Provider Details

I. General information

NPI: 1700442159
Provider Name (Legal Business Name): YITZAK FOX DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2019
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3708 NORTHSIDE DR
MACON GA
31210-2404
US

IV. Provider business mailing address

3708 NORTHSIDE DR
MACON GA
31210-2404
US

V. Phone/Fax

Practice location:
  • Phone: 478-745-4206
  • Fax: 478-254-5463
Mailing address:
  • Phone: 478-745-4206
  • Fax: 478-254-5463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberDR75336
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberOS17065
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number112232
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: