Provider Demographics
NPI:1760434757
Name:YARIMA, WAKILI SALIHU (MD)
Entity Type:Individual
Prefix:
First Name:WAKILI
Middle Name:SALIHU
Last Name:YARIMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3095 PARRISH RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-0386
Mailing Address - Country:US
Mailing Address - Phone:706-945-0729
Mailing Address - Fax:
Practice Address - Street 1:1120 15TH STREET AF 2036, EMERGENCY MEDICINE DEPARTMENT
Practice Address - Street 2:MEDICAL COLLEGE OF GEORGIA
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912
Practice Address - Country:US
Practice Address - Phone:706-721-3046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002348207P00000X
GA004610363A00000X
TXPA 01359363A00000X
NY004050-1363A00000X
TXN7191207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S60784Medicare UPIN