1982699112 NPI number — DR. DONNA J YEISER MD

Table of content: SCOTT A NICOL M.D. (NPI 1902808447)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982699112 NPI number — DR. DONNA J YEISER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YEISER
Provider First Name:
DONNA
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982699112
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 BROOKSTONE CENTRE PARKWAY
Provider Second Line Business Mailing Address:
#100
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-221-4602
Provider Business Mailing Address Fax Number:
706-221-4620

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 BROOKSTONE CENTRE PARKWAY
Provider Second Line Business Practice Location Address:
#100
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-221-4602
Provider Business Practice Location Address Fax Number:
706-221-4620
Provider Enumeration Date:
09/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  042981 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000734214D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000734214C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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