Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | RN240093 | GA |
NPI | 1033750781 |
---|---|
Provider Name | Yhaneek N Douglas-Mattis |
First Address | Mcdonough, GA 30252-4080 |
Second Address | Atlanta, GA 30303-3031 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2019 |
Last Update Date | 03/10/2019 |