Provider Demographics
NPI:1881134831
Name:YAGODA, ABBY POLLICK (PA-C)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:POLLICK
Last Name:YAGODA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ABBY
Other - Middle Name:
Other - Last Name:POLLICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:POLLOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28573-0068
Mailing Address - Country:US
Mailing Address - Phone:910-938-3099
Mailing Address - Fax:910-938-3243
Practice Address - Street 1:4275 WESTERN BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-1100
Practice Address - Country:US
Practice Address - Phone:910-938-3099
Practice Address - Fax:910-938-3243
Is Sole Proprietor?:No
Enumeration Date:2017-02-24
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-08791363A00000X
PAMA058887363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant