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General NPI Number Information
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NPI Number | 1588905871
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Entity Type | Organization
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Legal Business Name | SHELLY YUSUFF, M.D., P.C.
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Dates
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Enumeration Date | 03/11/2013
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Last Update Date | 03/11/2013
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Provider Practice Location Address
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Address Line | 1844 OLD NORCROSS RD SUITE 200
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-2923
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Country | US
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Telephone | 678-377-1100
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Fax | 678-377-8014
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Provider Business Mailing Address
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Address Line | 1844 OLD NORCROSS RD SUITE 200
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-2923
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Country | US
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Telephone | 678-377-1100
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Fax | 678-377-8014
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Authorized Official
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Title or Position | CEO/OWNER
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Name | SHELLY YUSUFF
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Credential | M.D.
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Telephone | 678-377-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 049482
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License Number State | GA
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