Provider Demographics
NPI:1134535107
Name:WYATT, YAKA
Entity type:Individual
Prefix:
First Name:YAKA
Middle Name:
Last Name:WYATT
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 1:345 WINDING RIVER DR
Mailing Address - Street 2:C
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30350-1966
Mailing Address - Country:US
Mailing Address - Phone:404-482-3985
Mailing Address - Fax:
Practice Address - Street 1:345 WINDING RIVER DR
Practice Address - Street 2:C
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30350-1966
Practice Address - Country:US
Practice Address - Phone:404-482-3985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No174H00000XOther Service ProvidersHealth Educator