Provider Demographics
NPI:1124036934
Name:YE, GE (DPM)
Entity Type:Individual
Prefix:DR
First Name:GE
Middle Name:
Last Name:YE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 RIVER VALLEY TRL
Mailing Address - Street 2:
Mailing Address - City:KATHLEEN
Mailing Address - State:GA
Mailing Address - Zip Code:31047-2139
Mailing Address - Country:US
Mailing Address - Phone:478-997-9485
Mailing Address - Fax:
Practice Address - Street 1:2180 VINEVILLE AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-3124
Practice Address - Country:US
Practice Address - Phone:478-742-3631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2016-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003589367H00000X
GAPOD001232213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100002074BMedicaid
GAP00123543OtherRAILROAD MEDICARE
GA100002074BMedicaid
GA100002074BMedicaid