Healthcare Provider Details

I. General information

NPI: 1396801387
Provider Name (Legal Business Name): CAROLINE DU YAPHOCKUN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 07/21/2020
Certification Date: 07/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 JOHN MADDOX DRIVE CONNECTOR NW
ROME GA
30165-1233
US

IV. Provider business mailing address

221 TECHNOLOGY PKWY NW
ROME GA
30165-1369
US

V. Phone/Fax

Practice location:
  • Phone: 762-235-2990
  • Fax: 706-238-8031
Mailing address:
  • Phone: 762-235-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number053213
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: