Healthcare Provider Details

I. General information

NPI: 1114860806
Provider Name (Legal Business Name): NICHOLAS YARBROUGH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1063 NATHAN DEAN BYP
ROCKMART GA
30153-2011
US

IV. Provider business mailing address

PO BOX 12938
CALHOUN GA
30703-7013
US

V. Phone/Fax

Practice location:
  • Phone: 678-685-9517
  • Fax: 770-647-8836
Mailing address:
  • Phone: 706-602-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP269306
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: