Provider Demographics
NPI:1982946471
Name:YODER, JENNA (DO)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:YODER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 MOUNT VERNON HWY NE STE 125
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4294
Mailing Address - Country:US
Mailing Address - Phone:937-384-6800
Mailing Address - Fax:770-804-1684
Practice Address - Street 1:800 MOUNT VERNON HWY NE STE 125
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4294
Practice Address - Country:US
Practice Address - Phone:770-804-1684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-22
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA306667207W00000X
NC2018-01148207W00000X
GA90822207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty