Provider Demographics
NPI:1881897031
Name:YANCEY, PATRICK HENRY III (DMD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:HENRY
Last Name:YANCEY
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-1572
Mailing Address - Country:US
Mailing Address - Phone:770-253-4241
Mailing Address - Fax:770-253-0063
Practice Address - Street 1:119 JACKSON ST
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-1572
Practice Address - Country:US
Practice Address - Phone:770-253-4241
Practice Address - Fax:770-253-0063
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA105851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice