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General NPI Number Information
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NPI Number | 1033210521
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Entity Type | Organization
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Legal Business Name | DR. JUDITH S. YONGUE
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 107 COMMERCE ST D
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City | GREENVILLE
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State | NC
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Zip | 27858-5027
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Country | US
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Telephone | 252-355-2768
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Fax | 252-355-0403
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Provider Business Mailing Address
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Address Line | PO BOX 30696
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City | GREENVILLE
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State | NC
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Zip | 27833-0696
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Country | US
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Telephone | 252-353-7162
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Fax | 252-353-1760
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Authorized Official
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Title or Position | CONSULTANT
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Name | DR. MARCUS W. GILLIKIN
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Credential | MD, MBA
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Telephone | 252-353-7162
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 13542
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License Number State | NC
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