Healthcare Provider Details

I. General information

NPI: 1861712259
Provider Name (Legal Business Name): HENAKU K YIRENKYI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2010
Last Update Date: 08/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 EAGLES LANDING PKWY SUITE 300
STOCKBRIDGE GA
30281-5170
US

IV. Provider business mailing address

900 CIRCLE 75 PKWY SE SUITE 1700
ATLANTA GA
30339-3035
US

V. Phone/Fax

Practice location:
  • Phone: 770-506-4350
  • Fax: 770-506-9860
Mailing address:
  • Phone: 770-953-6929
  • Fax: 770-953-6972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number076235
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: