Provider Demographics
NPI:1639395379
Name:YARBROUGH, TERRY LEE (OD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:LEE
Last Name:YARBROUGH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3485 ROLLING CREEK DR
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-4516
Mailing Address - Country:US
Mailing Address - Phone:678-546-4834
Mailing Address - Fax:
Practice Address - Street 1:400 SHALLOWFORD RD NW
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30504-4152
Practice Address - Country:US
Practice Address - Phone:770-503-7334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001902152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist