Healthcare Provider Details

I. General information

NPI: 1821445446
Provider Name (Legal Business Name): JOYLYN YEAZELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2016
Last Update Date: 01/06/2022
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1473 NC 42 43 W
PINETOPS NC
27864-7188
US

IV. Provider business mailing address

1473 NC 42 43 W
PINETOPS NC
27864-7188
US

V. Phone/Fax

Practice location:
  • Phone: 252-827-5231
  • Fax: 252-827-5775
Mailing address:
  • Phone: 252-827-5231
  • Fax: 252-827-5775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD467729
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02257
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number83237
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: