Provider Demographics
NPI:1922357284
Name:YATAWARA GYNECOLOGY WELLNESS AND AESTHETICS PC
Entity Type:Organization
Organization Name:YATAWARA GYNECOLOGY WELLNESS AND AESTHETICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:J
Authorized Official - Last Name:SINGLETON-YATAWARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-754-8990
Mailing Address - Street 1:415 STATESVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2317
Mailing Address - Country:US
Mailing Address - Phone:704-754-8990
Mailing Address - Fax:704-754-8991
Practice Address - Street 1:415 STATESVILLE BLVD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2317
Practice Address - Country:US
Practice Address - Phone:704-754-8990
Practice Address - Fax:704-754-8991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-02
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5921499Medicaid
NC5921499Medicaid