Provider Demographics
NPI:1467002220
Name:YAGER, GREGORY ALAN
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:ALAN
Last Name:YAGER
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 1:4646 FORSYTH RD STE 120
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-4465
Mailing Address - Country:US
Mailing Address - Phone:478-953-0056
Mailing Address - Fax:
Practice Address - Street 1:4646 FORSYTH RD STE 120
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-4465
Practice Address - Country:US
Practice Address - Phone:478-953-0056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAHDS001027237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist