Provider Demographics
NPI:1043297898
Name:YAUN, JOEL STEVEN (CRNA)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:STEVEN
Last Name:YAUN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1690
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:GA
Mailing Address - Zip Code:31539-1690
Mailing Address - Country:US
Mailing Address - Phone:912-375-7781
Mailing Address - Fax:912-375-4055
Practice Address - Street 1:163 S TALLAHASSEE ST
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:GA
Practice Address - Zip Code:31539-6465
Practice Address - Country:US
Practice Address - Phone:912-375-7781
Practice Address - Fax:912-375-4055
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAR152319367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00893593AMedicaid