Provider Demographics
NPI:1790319283
Name:YODER, STANLEY JOAS (APRN)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:JOAS
Last Name:YODER
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:STANLEY
Other - Middle Name:J
Other - Last Name:YODER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:531 ASBURY CIRCLE - ANNEX SUITE N340
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322
Mailing Address - Country:US
Mailing Address - Phone:404-778-5975
Mailing Address - Fax:404-778-2630
Practice Address - Street 1:1364 CLIFTON RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322
Practice Address - Country:US
Practice Address - Phone:404-778-5975
Practice Address - Fax:404-778-2630
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN259453363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily