Provider Demographics
NPI:1245336668
Name:YANDEL, SUSAN EILEEN (NP)
Entity type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:EILEEN
Last Name:YANDEL
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:3092 BELINGHAM DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-1575
Mailing Address - Country:US
Mailing Address - Phone:404-731-6788
Mailing Address - Fax:404-592-6823
Practice Address - Street 1:1640 POWERS FERRY RD
Practice Address - Street 2:BUILDING 9, SUITE 300
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-5491
Practice Address - Country:US
Practice Address - Phone:404-731-6788
Practice Address - Fax:404-592-6823
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2011-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN115022363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000887125BMedicaid
GA50BBJSNMedicare ID - Type Unspecified
GAP18525Medicare UPIN