Provider Demographics
NPI:1750676813
Name:MINES, YOLANDA JOY (MD)
Entity Type:Individual
Prefix:MRS
First Name:YOLANDA
Middle Name:JOY
Last Name:MINES
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:PO BOX 743904
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3904
Mailing Address - Country:US
Mailing Address - Phone:803-296-7320
Mailing Address - Fax:803-296-7330
Practice Address - Street 1:1301 TAYLOR ST STE 6J
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2930
Practice Address - Country:US
Practice Address - Phone:803-296-2942
Practice Address - Fax:803-779-9581
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC33676207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC336764Medicaid
SCSC98609505Medicare PIN