Provider Demographics
NPI:1598929630
Name:TRUITT, YORMICA L (PA-C)
Entity Type:Individual
Prefix:MS
First Name:YORMICA
Middle Name:L
Last Name:TRUITT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3106 SAVANNAH LN
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31721-1983
Mailing Address - Country:US
Mailing Address - Phone:229-894-1884
Mailing Address - Fax:
Practice Address - Street 1:1775 ACCESS RD STE C
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-1987
Practice Address - Country:US
Practice Address - Phone:770-255-0123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005341363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical