Provider Demographics
NPI:1457813677
Name:MOUNT YONAH MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:MOUNT YONAH MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:MERKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-398-1764
Mailing Address - Street 1:230 SCOTCH PINE CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-7911
Mailing Address - Country:US
Mailing Address - Phone:770-238-2674
Mailing Address - Fax:561-516-8354
Practice Address - Street 1:10019 REISTERSTOWN RD STE 205
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-3902
Practice Address - Country:US
Practice Address - Phone:410-303-9923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-05
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory