Provider Demographics
NPI:1417960360
Name:YANCEY, ERIC LEON (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:LEON
Last Name:YANCEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 W LOWMAN ST
Mailing Address - Street 2:
Mailing Address - City:MULLINS
Mailing Address - State:SC
Mailing Address - Zip Code:29574-3107
Mailing Address - Country:US
Mailing Address - Phone:843-464-4000
Mailing Address - Fax:843-464-4017
Practice Address - Street 1:119 W LOWMAN ST
Practice Address - Street 2:
Practice Address - City:MULLINS
Practice Address - State:SC
Practice Address - Zip Code:29574-3107
Practice Address - Country:US
Practice Address - Phone:843-464-4000
Practice Address - Fax:843-464-4017
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101223145208600000X
SC35245208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010118271Medicaid
VA175116OtherANTHEM
VA175116OtherANTHEM
VA$$$$$$$$$OtherTRICARE
VA010118271Medicaid
VA175116OtherANTHEM