Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | G18612 | GA |
N | 207ND0101X | MOHS-Micrographic Surgeon | GA18612 | GA |
N | 207NS0135X | Procedural Dermatology | GA18612 | GA |
NPI | 1003831868 |
---|---|
Provider Name | Dr. Avis Brown Yount |
First Address | Augusta, GA 30901 |
Second Address | Augusta, GA 30901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 09/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
070005945 | RAILROAD MEDICARE (01) | GA |
D31646 | (02) |