Healthcare Provider Details

I. General information

NPI: 1861435737
Provider Name (Legal Business Name): HAROLD YAWN JR. CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8800 N TRYON ST
CHARLOTTE NC
28262-3300
US

IV. Provider business mailing address

PO BOX 560727 ANESTHESIA DEPARTMENT
CHARLOTTE NC
28256-0727
US

V. Phone/Fax

Practice location:
  • Phone: 704-863-5664
  • Fax: 704-863-5848
Mailing address:
  • Phone: 704-863-5664
  • Fax: 704-863-5848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number41168
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number24241
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: