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1380 Us Highway 41 Vienna GA 31092-7744 | |
(229) 598-0595 | |
(206) 471-6113 |
Full Name | |
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Speciality | Family Medicine |
Location | 1380 Us Highway 41, Vienna, Georgia |
Authorized Official Name and Position | Melanie Kinard Yawn (OWNER) |
Authorized Official Contact | 2298869139 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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1380 Us Highway 41 Vienna GA 31092-7744 Ph: (229) 598-0595 | 1380 Us Highway 41 Vienna GA 31092-7744 Ph: (229) 598-0595 |
NPI Number | 1982362224 |
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Provider Enumeration Date | 12/03/2021 |
Last Update Date | 03/21/2022 |
Medicare PECOS PAC ID | 0345627022 |
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Medicare Enrollment ID | O20220518002297 |
Identifier | Type | State | Issuer |
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1982362224 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Jorge B Pisarello |
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Provider Type | Practitioner - Undersea And Hyperbaric Medicine |
Provider Identifiers | NPI Number: 1992795876 PECOS PAC ID: 8628017340 Enrollment ID: I20070409000466 |
Provider Name | Melanie K Yawn |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1295149029 PECOS PAC ID: 2264748649 Enrollment ID: I20150831001703 |