Provider Demographics
NPI:1417372814
Name:YANCEY, PATRICK HENRY IV
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:HENRY
Last Name:YANCEY
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2068 WALTON WAY
Mailing Address - Street 2:APT 204
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-4156
Mailing Address - Country:US
Mailing Address - Phone:678-378-7740
Mailing Address - Fax:
Practice Address - Street 1:2068 WALTON WAY
Practice Address - Street 2:APT 204
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-4156
Practice Address - Country:US
Practice Address - Phone:678-378-7740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-22
Last Update Date:2014-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program