Provider Demographics
NPI:1225109838
Name:INTERNAL MEDICINE ASSOCIATES OF JASPER, PC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF JASPER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANIL
Authorized Official - Middle Name:
Authorized Official - Last Name:YADAV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-692-9768
Mailing Address - Street 1:51 GORDON RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-1017
Mailing Address - Country:US
Mailing Address - Phone:706-692-9768
Mailing Address - Fax:706-692-4040
Practice Address - Street 1:51 GORDON RD
Practice Address - Street 2:SUITE 201
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-1017
Practice Address - Country:US
Practice Address - Phone:706-692-9768
Practice Address - Fax:706-692-4040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA709443213AMedicaid
GABY8609779OtherDR. MONIKA YADAV DEA
GA709443213AMedicaid
GABY8609779OtherDR. MONIKA YADAV DEA
GA709443213AMedicaid
GAGRP6304Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER