Provider Demographics
NPI:1831960426
Name:YANCEY, ALECIA (LDO)
Entity type:Individual
Prefix:
First Name:ALECIA
Middle Name:
Last Name:YANCEY
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4195 THAYER DR
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-5643
Mailing Address - Country:US
Mailing Address - Phone:404-372-2209
Mailing Address - Fax:
Practice Address - Street 1:6520 ERNEST BARRETT PKWY
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-4571
Practice Address - Country:US
Practice Address - Phone:770-222-6603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALDO002137156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician