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General NPI Number Information
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NPI Number | 1245239094
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Entity Type | Individual
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Provider Name | MARK J. YANTA M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/14/2005
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Last Update Date | 02/01/2017
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Provider Practice Location Address
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Address Line | 3400 OLD MILTON PKWY # C STE 365
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City | ALPHARETTA
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State | GA
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Zip | 30005-3707
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Country | US
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Telephone | 404-446-2400
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Fax | 404-446-2409
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Provider Business Mailing Address
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Address Line | 3400 OLD MILTON PKWY # C STE 365
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City | ALPHARETTA
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State | GA
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Zip | 30005-3707
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Country | US
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Telephone | 404-446-2400
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Fax | 404-446-2409
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 043827
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 43827
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License Number State | GA
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