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General NPI Number Information
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NPI Number | 1114979499
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Entity Type | Individual
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Provider Name | THEODORE LEON YARBORO JR. MD
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Gender | Male
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 07/26/2011
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Provider Practice Location Address
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Address Line | 610 SPARTA RD
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City | SANDERSVILLE
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State | GA
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Zip | 31082-1860
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Country | US
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Telephone | 478-240-2125
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Fax |
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Provider Business Mailing Address
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Address Line | 465 PLANTATION DR
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City | SANDERSVILLE
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State | GA
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Zip | 31082-7453
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Country | US
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Telephone | 478-552-6787
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 037929
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 37929
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License Number State | GA
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