Provider Demographics
NPI:1003188152
Name:COMBS, YESNIA (MA, ATC, LAT LPN)
Entity Type:Individual
Prefix:MRS
First Name:YESNIA
Middle Name:
Last Name:COMBS
Suffix:
Gender:F
Credentials:MA, ATC, LAT LPN
Other - Prefix:MS
Other - First Name:YESENIA
Other - Middle Name:
Other - Last Name:OCHOA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4601 NOAH OVERLOOK E
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-6854
Mailing Address - Country:US
Mailing Address - Phone:770-876-0571
Mailing Address - Fax:770-423-6665
Practice Address - Street 1:1000 CHASTAIN RD NW # 201
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-5588
Practice Address - Country:US
Practice Address - Phone:770-794-7716
Practice Address - Fax:770-423-6665
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN076548164X00000X
GAAT001439207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
No164X00000XNursing Service ProvidersLicensed Vocational Nurse