Provider Demographics
NPI:1720078744
Name:YANKEE, ELLEN TAYLOR (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:TAYLOR
Last Name:YANKEE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 CLAIRMONT CIR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-5317
Mailing Address - Country:US
Mailing Address - Phone:404-320-0858
Mailing Address - Fax:
Practice Address - Street 1:1814 CLAIRMONT RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-3405
Practice Address - Country:US
Practice Address - Phone:404-636-1457
Practice Address - Fax:404-636-7449
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002180103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA68BBFTJMedicare ID - Type Unspecified