Provider Demographics
NPI:1700852548
Name:YATES, TOMMY EUGENE (DO)
Entity Type:Individual
Prefix:DR
First Name:TOMMY
Middle Name:EUGENE
Last Name:YATES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100559
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-0559
Mailing Address - Country:US
Mailing Address - Phone:843-664-4300
Mailing Address - Fax:843-664-4308
Practice Address - Street 1:603 W ALABAMA ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-6006
Practice Address - Country:US
Practice Address - Phone:256-168-8340
Practice Address - Fax:256-768-9693
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO393207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01575874Medicaid
AL51078030OtherBCBS
AL51078030OtherBCBS