Provider Demographics
NPI:1093886541
Name:YATES, LAURIE J (CRNA)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:J
Last Name:YATES
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 28068
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37424-8068
Mailing Address - Country:US
Mailing Address - Phone:877-899-1033
Mailing Address - Fax:423-892-5838
Practice Address - Street 1:1120 15TH ST
Practice Address - Street 2:ROOM 2144
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-0004
Practice Address - Country:US
Practice Address - Phone:706-721-3873
Practice Address - Fax:706-721-7763
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN110884367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000576056BMedicaid
GA000576056CMedicaid
GA339355OtherWELLCARE CMO
GA430079464OtherRRMEDICARE
GA550789920OtherTRICARE
SCGAN107Medicaid
GA550789920OtherTRICARE