Provider Demographics
NPI:1114959392
Name:YEATTS, DONALD E (MD, DDS)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:E
Last Name:YEATTS
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13911 ST FRANCIS BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-3256
Mailing Address - Country:US
Mailing Address - Phone:804-320-3999
Mailing Address - Fax:804-323-9383
Practice Address - Street 1:13911 ST FRANCIS BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-3256
Practice Address - Country:US
Practice Address - Phone:804-320-3999
Practice Address - Fax:804-323-9383
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101046906207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA019974F47Medicare UPIN
VAC01247Medicare PIN
VAF54603Medicare UPIN
VA5292089OtherAETNA HMO
VA5292089OtherAETNA LIFE
VA182430OtherBCBS OF VA
VA311893OtherSOUTHERN HEALTH SERVICES
VA014007P95Medicare PIN
00W585B04Medicare ID - Type Unspecified
VA21660OtherSENTARA