Provider Demographics
NPI:1801204409
Name:JARRETT, YVONNE G
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:G
Last Name:JARRETT
Suffix:
Gender:F
Credentials:
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 741
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30301-0741
Mailing Address - Country:US
Mailing Address - Phone:404-557-9998
Mailing Address - Fax:
Practice Address - Street 1:2651 FLINTLOCK LN SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30008-5016
Practice Address - Country:US
Practice Address - Phone:404-557-9998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-27
Last Update Date:2014-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service