MEDICARE: RAVI DAVID YARID D.O.

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	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	5101016264	MI
2	207Q00000X	Family Medicine Physician	5101016264	MI
3	390200000X	Student in an Organized Health Care Education/Training Program	2013	ME
4	207Q00000X	Family Medicine Physician	89309	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	085300025	OTHER	MI	BCN
2	085300025	OTHER	MI	BCBS

General Provider Information

NPI Number	:	1902005762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAVI DAVID YARID D.O.

Provider Business Mailing Address
First Line	:	725 MOUNT OGLETHORPE TRL
Second Line	:
City	:	JOHNS CREEK
State	:	GA
Zip	:	30022-7105
Country	:	US
Telephone Number	:	207-907-9695
Fax Number	:

Provider Business Practice Location Address
First Line	:	2637 PEACHTREE PKWY
Second Line	:
City	:	SUWANEE
State	:	GA
Zip	:	30024-1048
Country	:	US
Telephone Number	:	314-898-6188
Fax Number	:

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

Provider Enumeration Date	:	07/12/2007
Last Update Date	:	09/21/2023

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Directions to “ RAVI DAVID YARID D.O.” Practice Location

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