Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 73676 | GA |
N | 2080A0000X | Adolescent Medicine | 140477-1 | NY |
NPI | 1154362366 |
---|---|
Provider Name | Dr. Ferdinand Domenic Yates JR. |
First Address | Woodstock, GA 30188-4093 |
Second Address | Woodstock, GA 30188-4093 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 03/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
003169014A | (05) | GA |
00669374 | (05) | NY |
F22523 | (02) | NY |