Provider Demographics
NPI:1932205879
Name:YAGNICK, HEMANT K (MD)
Entity Type:Individual
Prefix:DR
First Name:HEMANT
Middle Name:K
Last Name:YAGNICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 TOWN PARK BOULEVARD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809
Mailing Address - Country:US
Mailing Address - Phone:706-922-7246
Mailing Address - Fax:
Practice Address - Street 1:404 TOWN PARK BOULEVARD
Practice Address - Street 2:SUITE 101
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809
Practice Address - Country:US
Practice Address - Phone:706-922-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055321207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA558 441 890 BMedicaid
GA05 BD KZGMedicare ID - Type Unspecified
GA558 441 890 BMedicaid