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General NPI Number Information
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NPI Number | 1619468105
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Entity Type | Organization
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Legal Business Name | YELLOW CREEK PRIMARY CARE, INC.
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Dates
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Enumeration Date | 05/21/2018
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Last Update Date | 06/06/2018
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Provider Practice Location Address
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Address Line | 3453 GRANGER RD
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City | AKRON
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State | OH
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Zip | 44333
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Country | US
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Telephone | 234-466-7395
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Fax |
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Provider Business Mailing Address
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Address Line | 3453 GRANGER RD
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City | AKRON
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State | OH
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Zip | 44333-1532
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Country | US
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Telephone | 234-466-7395
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LORI GEMMA
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Credential | DO
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Telephone | 330-239-4989
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 34007700
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License Number State | OH
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