Provider Demographics
NPI:1194225565
Name:DEYOE, JAMES DONALD (LAC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DONALD
Last Name:DEYOE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 FAWN RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:RABUN GAP
Mailing Address - State:GA
Mailing Address - Zip Code:30568-2825
Mailing Address - Country:US
Mailing Address - Phone:678-982-7714
Mailing Address - Fax:
Practice Address - Street 1:37 FAWN RIDGE TRL
Practice Address - Street 2:
Practice Address - City:RABUN GAP
Practice Address - State:GA
Practice Address - Zip Code:30568-2825
Practice Address - Country:US
Practice Address - Phone:678-982-7714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA417171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist