Provider Demographics
NPI:1063527067
Name:TAYARA, YAMAN (MD)
Entity type:Individual
Prefix:DR
First Name:YAMAN
Middle Name:
Last Name:TAYARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:YAMAN
Other - Middle Name:
Other - Last Name:TAYARA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:962 JOE FRANK HARRIS PKWY #106
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-0120
Mailing Address - Country:US
Mailing Address - Phone:770-382-1926
Mailing Address - Fax:770-387-0343
Practice Address - Street 1:962 JOE FRANK HARRIS PKWY #106
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-0120
Practice Address - Country:US
Practice Address - Phone:770-382-1926
Practice Address - Fax:770-387-0343
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045641174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1924620OtherAETNA MGD CHOICE
GAF82853OtherSTATE HEALTH
GA006548OtherBLUE CROSS BLUE SHIELD
GA7115242OtherAETNA HMO
GA10036428OtherAMERIGROUP
GAP00099422OtherRR MEDICARE
GA2900337OtherUNITED HEALTH CARE
GA9330560OtherCIGNA
GAP00099422OtherRR MEDICARE
GA10036428OtherAMERIGROUP