Provider Demographics
NPI:1376831164
Name:JOHNSON, YVONNE FRY (MD, MSCR)
Entity Type:Individual
Prefix:DR
First Name:YVONNE
Middle Name:FRY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD, MSCR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 TALL PINE CIR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-4538
Mailing Address - Country:US
Mailing Address - Phone:404-449-4018
Mailing Address - Fax:844-370-1747
Practice Address - Street 1:211 BOBBY JONES EXPY STE C
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-5253
Practice Address - Country:US
Practice Address - Phone:706-364-5533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-14
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA29172208000000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics