Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 20501 | GA |
Y | 2080A0000X | Adolescent Medicine | 020501 | GA |
NPI | 1013908342 |
---|---|
Provider Name | Abolhassan Yamin |
First Address | Douglasville, GA 30134-1822 |
Second Address | Douglasville, GA 30134-1822 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2005 |
Last Update Date | 02/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000177449E | (05) | GA |
D16338 | (02) | GA |