Healthcare Provider Details

I. General information

NPI: 1457813677
Provider Name (Legal Business Name): MOUNT YONAH MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2019
Last Update Date: 10/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10019 REISTERSTOWN RD STE 205
OWINGS MILLS MD
21117-3902
US

IV. Provider business mailing address

230 SCOTCH PINE CT
ALPHARETTA GA
30022-7911
US

V. Phone/Fax

Practice location:
  • Phone: 410-303-9923
  • Fax:
Mailing address:
  • Phone: 770-238-2674
  • Fax: 561-516-8354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: ANDREW MERKER
Title or Position: VP
Credential:
Phone: 561-398-1764