=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962561332
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CONSTANCE YEARLING MD MPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2006
-----------------------------------------------------
Last Update Date | 08/15/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1332 PICKENS ST THE NURTURING CENTER
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29201-3430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-771-4160
-----------------------------------------------------
Fax | 803-771-4367
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3788
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29230-3788
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-733-5969
-----------------------------------------------------
Fax | 803-217-0026
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 10717
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------