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General NPI Number Information
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NPI Number | 1104895762
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Entity Type | Individual
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Provider Name | JERRY YUAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/16/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 11459 JOHNS CREEK PKWY SUITE 170
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City | JOHNS CREEK
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State | GA
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Zip | 30097-3515
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Country | US
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Telephone | 678-417-0400
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Fax | 678-417-0483
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Provider Business Mailing Address
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Address Line | 1930 BRANNAN RD
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City | MCDONOUGH
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State | GA
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Zip | 30253-4310
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Country | US
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Telephone | 678-284-4040
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Fax | 678-284-4076
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 042495
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License Number State | GA
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