Provider Demographics
NPI:1154362366
Name:YATES, FERDINAND DOMENIC JR (MD)
Entity type:Individual
Prefix:DR
First Name:FERDINAND
Middle Name:DOMENIC
Last Name:YATES
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:2000 PROFESSIONAL WAY
Mailing Address - Street 2:#200
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-4093
Mailing Address - Country:US
Mailing Address - Phone:770-517-0250
Mailing Address - Fax:770-517-0260
Practice Address - Street 1:2000 PROFESSIONAL WAY
Practice Address - Street 2:#200
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-4093
Practice Address - Country:US
Practice Address - Phone:770-517-0250
Practice Address - Fax:770-517-0260
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2016-05-03
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Provider Licenses
StateLicense IDTaxonomies
NY140477-12080A0000X
GA73676208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00669374Medicaid
GA003169014AMedicaid
GA003169014AMedicaid