Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | G18569 | GA |
N | 207NS0135X | Procedural Dermatology | GA18569 | GA |
NPI | 1376568147 |
---|---|
Provider Name | Dr. Peter S Yount |
First Address | Augusta, GA 30901 |
Second Address | Augusta, GA 30901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D41453 | (02) |