Provider Demographics
NPI:1265504575
Name:YANK, GLENN R (MD)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:R
Last Name:YANK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 475
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38402-0475
Mailing Address - Country:US
Mailing Address - Phone:931-490-0999
Mailing Address - Fax:931-490-0555
Practice Address - Street 1:854 W JAMES CAMPBELL BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-4659
Practice Address - Country:US
Practice Address - Phone:931-490-0999
Practice Address - Fax:931-490-0555
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNMD294652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNF21196Medicare UPIN