Healthcare Provider Details

I. General information

NPI: 1376534735
Provider Name (Legal Business Name): YATES & SEIB, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HAYES ST
TOCCOA GA
30577-2067
US

IV. Provider business mailing address

100 HAYES ST P.O. BOX 399
TOCCOA GA
30577-2067
US

V. Phone/Fax

Practice location:
  • Phone: 706-886-3883
  • Fax: 706-886-3812
Mailing address:
  • Phone: 706-886-3883
  • Fax: 706-886-3812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberPT001906,PT001873
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier00817979A, 00817957A
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer

VIII. Authorized Official

Name: MRS. ELLEN M. SEIB
Title or Position: CO-OWNER
Credential: P.T.
Phone: 706-886-3883