Provider Demographics
NPI:1558661330
Name:JAMES A YECKLEY MD PC
Entity Type:Organization
Organization Name:JAMES A YECKLEY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SLAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-354-8866
Mailing Address - Street 1:835 E 65TH ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4421
Mailing Address - Country:US
Mailing Address - Phone:912-354-8866
Mailing Address - Fax:912-353-8460
Practice Address - Street 1:835 E 65TH ST
Practice Address - Street 2:SUITE 107
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4421
Practice Address - Country:US
Practice Address - Phone:912-354-8866
Practice Address - Fax:912-353-8460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA17909174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000081991AMedicaid
GA000081991AMedicaid