Provider Demographics
NPI:1770251431
Name:YANCY, CAROL JONES (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:JONES
Last Name:YANCY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1552 FLAGLER RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-9566
Mailing Address - Country:US
Mailing Address - Phone:706-339-7553
Mailing Address - Fax:
Practice Address - Street 1:1552 FLAGLER RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-9566
Practice Address - Country:US
Practice Address - Phone:706-339-7553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACO118068174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist