Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 26588 | MS |
N | 111NI0900X | Internist | 26588 | MS |
N | 207R00000X | Internist | 3793 | TN |
N | 111NI0900X | Internist | 3793 | TN |
N | 207R00000X | Internist | T-3032 | MS |
N | 111NI0900X | Internist | T-3032 | MS |
Y | 207RN0300X | Nephrologist | 3793 | TN |
NPI | 1013390467 |
---|---|
Provider Name | Dr. Justin Leonadus Yancey |
First Address | Germantown, TN 38138-1744 |
Second Address | Germantown, TN 38138-1744 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2015 |
Last Update Date | 03/03/2021 |