Provider Demographics
NPI:1801496781
Name:XIAO, YANFANG
Entity type:Individual
Prefix:
First Name:YANFANG
Middle Name:
Last Name:XIAO
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 1:2675 N DECATUR RD STE 607
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-6134
Mailing Address - Country:US
Mailing Address - Phone:470-226-1601
Mailing Address - Fax:470-225-6345
Practice Address - Street 1:2675 N DECATUR RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6131
Practice Address - Country:US
Practice Address - Phone:470-226-1601
Practice Address - Fax:470-225-6345
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN281266363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily