Provider Demographics
NPI:1780875674
Name:HEAD, YAMEIKA A (MD)
Entity type:Individual
Prefix:DR
First Name:YAMEIKA
Middle Name:A
Last Name:HEAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-6840
Mailing Address - Country:US
Mailing Address - Phone:478-633-7600
Mailing Address - Fax:478-633-5374
Practice Address - Street 1:744 1ST ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-6840
Practice Address - Country:US
Practice Address - Phone:478-633-7600
Practice Address - Fax:478-633-5374
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200976208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1508446Medicaid