Provider Demographics
NPI:1750474987
Name:YADAV, MONIKA S (MD)
Entity Type:Individual
Prefix:DR
First Name:MONIKA
Middle Name:S
Last Name:YADAV
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 GORDON RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-1017
Mailing Address - Country:US
Mailing Address - Phone:706-692-9768
Mailing Address - Fax:706-692-4040
Practice Address - Street 1:684 SIXES RD STE 105
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30115-8720
Practice Address - Country:US
Practice Address - Phone:678-494-9669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054019207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA233896399AMedicaid
GA233896399AMedicaid
GA11SCCNQMedicare ID - Type Unspecified
GA233896399AMedicaid