Provider Demographics
NPI:1528202397
Name:YASH, AMBER ELIZABETH (LMT)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:ELIZABETH
Last Name:YASH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 BETH CT
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-6038
Mailing Address - Country:US
Mailing Address - Phone:678-559-6952
Mailing Address - Fax:912-393-3381
Practice Address - Street 1:105 SHIRLEY AVE
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-2325
Practice Address - Country:US
Practice Address - Phone:912-384-4494
Practice Address - Fax:912-393-3381
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT000549225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist