Provider Demographics
NPI:1225070261
Name:YAWN, ANTHONY (NP)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:YAWN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16100
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31040-6100
Mailing Address - Country:US
Mailing Address - Phone:478-296-2800
Mailing Address - Fax:478-296-2801
Practice Address - Street 1:1110 HILLCREST PKWY
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-3687
Practice Address - Country:US
Practice Address - Phone:478-296-2800
Practice Address - Fax:478-296-2801
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN104649363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA571021614BMedicaid
GAP89465Medicare UPIN
GA571021614BMedicaid