Provider Demographics
NPI:1437762747
Name:YANCEY, JAMES L
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:L
Last Name:YANCEY
Suffix:
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 1:112 N WILLOWCREST RD
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-6341
Mailing Address - Country:US
Mailing Address - Phone:706-333-9528
Mailing Address - Fax:
Practice Address - Street 1:1602 VERNON RD STE 400
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-4129
Practice Address - Country:US
Practice Address - Phone:068-829-3417
Practice Address - Fax:706-884-0131
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GARN269230363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program