Provider Demographics
NPI:1255052320
Name:VILFORT, YOSAN NEGGA (PA-C)
Entity type:Individual
Prefix:
First Name:YOSAN
Middle Name:NEGGA
Last Name:VILFORT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 PHOENIX BLVD STE 900
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-5597
Mailing Address - Country:US
Mailing Address - Phone:404-631-6156
Mailing Address - Fax:
Practice Address - Street 1:541 FOREST PKWY STE 14
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-6110
Practice Address - Country:US
Practice Address - Phone:678-949-9448
Practice Address - Fax:678-922-2133
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA111602084N0400X, 363AS0400X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical