=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194816280
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YONAH MOUNTAIN FAMILY PRACTICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2006
-----------------------------------------------------
Last Update Date | 11/28/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 55 CANTRELL RD STE. 100
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-348-8763
-----------------------------------------------------
Fax | 706-348-1931
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 55 CANTRELL RD STE. 100
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-348-8763
-----------------------------------------------------
Fax | 706-348-1931
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PHYSICIAN
-----------------------------------------------------
Name | DR. DENISE M WORKMAN
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 678-231-5999
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------