Provider Demographics
NPI:1194816280
Name:YONAH MOUNTAIN FAMILY PRACTICE
Entity Type:Organization
Organization Name:YONAH MOUNTAIN FAMILY PRACTICE
Other - Org Name:COUNTRY WAY FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WORKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:678-231-5999
Mailing Address - Street 1:55 CANTRELL RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:CLEVELAND
Mailing Address - State:GA
Mailing Address - Zip Code:30528
Mailing Address - Country:US
Mailing Address - Phone:706-348-8763
Mailing Address - Fax:706-348-1931
Practice Address - Street 1:55 CANTRELL RD
Practice Address - Street 2:STE. 100
Practice Address - City:CLEVELAND
Practice Address - State:GA
Practice Address - Zip Code:30528
Practice Address - Country:US
Practice Address - Phone:706-348-8763
Practice Address - Fax:706-348-1931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6015Medicare PIN