Provider Demographics
NPI:1194770826
Name:YANTCH, ANTHONY J (PA-AA)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:J
Last Name:YANTCH
Suffix:
Gender:M
Credentials:PA-AA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 932925
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-2925
Mailing Address - Country:US
Mailing Address - Phone:800-364-9216
Mailing Address - Fax:423-892-5838
Practice Address - Street 1:303 PARKWAY DR. NE
Practice Address - Street 2:PMB 404
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1212
Practice Address - Country:US
Practice Address - Phone:404-265-5620
Practice Address - Fax:404-265-3894
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA000228367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100000419FMedicaid
GA100000419DMedicaid
GA1982637419OtherGROUP NPI
GAN334534OtherWELLCARE
P00286235OtherRAILROAD MEDICARE
GU1194770826OtherNPI
$$$$$$$$$OtherCHAMPUS/TRICARE
GAN334534OtherWELLCARE
GAP42165Medicare UPIN