Provider Demographics
NPI:1194213140
Name:YANIS, ZACARIAS JR (PSYD)
Entity type:Individual
Prefix:
First Name:ZACARIAS
Middle Name:
Last Name:YANIS
Suffix:JR
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1276 MCCONNELL DRIVE STE C.
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033
Mailing Address - Country:US
Mailing Address - Phone:404-929-9009
Mailing Address - Fax:404-929-9005
Practice Address - Street 1:1276 MCCONNELL DRIVE STE C.
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033
Practice Address - Country:US
Practice Address - Phone:404-929-9009
Practice Address - Fax:404-929-9005
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY004173103G00000X
GAPSY00413103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist