Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 38686 | TX |
Y | 103T00000X | Psychologist | 38686 | TX |
NPI | 1013678432 |
---|---|
Provider Name | Dr. Justina Yohannan |
First Address | Macon, GA 31210-1674 |
Second Address | Macon, GA 31210-2376 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2022 |
Last Update Date | 07/01/2022 |