MEDICARE: DR. RANDY J YANDA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	036638	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407850076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDY J YANDA M.D.

Provider Business Mailing Address
First Line	:	95 COLLIER RD NW
Second Line	:	STE 4075
City	:	ATLANTA
State	:	GA
Zip	:	30309-1751
Country	:	US
Telephone Number	:	404-603-3543
Fax Number	:	404-350-8795

Provider Business Practice Location Address
First Line	:	95 COLLIER RD NW
Second Line	:	STE 4055
City	:	ATLANTA
State	:	GA
Zip	:	30309-1796
Country	:	US
Telephone Number	:	404-355-3200
Fax Number	:	404-351-7548

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	06/05/2009

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