Provider Demographics
NPI:1790743052
Name:YELVERTON, DENNIS ALVA (PA)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:ALVA
Last Name:YELVERTON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:275 COLLIE ROAD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309
Mailing Address - Country:US
Mailing Address - Phone:404-605-2800
Mailing Address - Fax:404-351-5983
Practice Address - Street 1:95 COLLIER ROAD
Practice Address - Street 2:SUITE 2075
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309
Practice Address - Country:US
Practice Address - Phone:404-605-2800
Practice Address - Fax:404-351-5983
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2014-05-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA002227363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA902763829AOtherPEACH STATE
GA902763829AMedicaid
GA402993OtherWELLCAR
GA902763829AOtherPEACH STATE
P28139Medicare UPIN