Provider Demographics
NPI:1518972496
Name:YANDLE, KYLE T (PA-C)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:T
Last Name:YANDLE
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:106 BROAD ST
Mailing Address - Street 2:APT 1632
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-7463
Mailing Address - Country:US
Mailing Address - Phone:678-635-8130
Mailing Address - Fax:678-635-8131
Practice Address - Street 1:2878 FIVE FORKS TRICKUM RD
Practice Address - Street 2:STE 2A
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-5896
Practice Address - Country:US
Practice Address - Phone:678-344-8700
Practice Address - Fax:678-344-8600
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2016-03-30
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Provider Licenses
StateLicense IDTaxonomies
GA004390363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical