Healthcare Provider Details

I. General information

NPI: 1902005762
Provider Name (Legal Business Name): RAVI DAVID YARID D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2637 PEACHTREE PKWY
SUWANEE GA
30024-1048
US

IV. Provider business mailing address

725 MOUNT OGLETHORPE TRL
JOHNS CREEK GA
30022-7105
US

V. Phone/Fax

Practice location:
  • Phone: 314-898-6188
  • Fax:
Mailing address:
  • Phone: 207-907-9695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2013
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number5101016264
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101016264
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number89309
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: