Provider Demographics
NPI:1659727634
Name:YATES, ANDREA L (PA-C)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:YATES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:L
Other - Last Name:FERGUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-3406
Mailing Address - Country:US
Mailing Address - Phone:912-547-4399
Mailing Address - Fax:
Practice Address - Street 1:10 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31410-3406
Practice Address - Country:US
Practice Address - Phone:912-547-4399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7948363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant