Healthcare Provider Details

I. General information

NPI: 1447213277
Provider Name (Legal Business Name): YOLLA JULES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 10/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 N OAK STREET EXT BEHAVIORAL HEALTH SERVICES OF SOUTH GA
VALDOSTA GA
31602-5909
US

IV. Provider business mailing address

3120 N OAK STREET EXT BEHAVIORAL HEALTH SERVICES OF SOUTH GA
VALDOSTA GA
31602-5909
US

V. Phone/Fax

Practice location:
  • Phone: 229-671-6170
  • Fax: 229-671-6779
Mailing address:
  • Phone: 229-671-6170
  • Fax: 229-671-6779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number15738
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number66174
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number66174
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: