MEDICARE: ASA YANCY HEALTH CENTER

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	261Q00000X	Clinic/Center	R042007	GA

General Provider Information

NPI Number	:	1447264163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASA YANCY HEALTH CENTER

Provider Business Mailing Address
First Line	:	1886 WINDEMERE DR NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30324-4918
Country	:	US
Telephone Number	:	404-874-4609
Fax Number	:

Provider Business Practice Location Address
First Line	:	1247 DONALD LEE HOLLOWELL PKWY NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-6657
Country	:	US
Telephone Number	:	404-616-2265
Fax Number	:	404-881-0622

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	DR. CARLA MAE SCHISSEL
Credential	:	R.N., PHD
Telephone Number	:	404-616-2265

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	10/31/2007

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