Provider Demographics
NPI:1215151352
Name:YAKUM, VIVIENNE (PAC)
Entity type:Individual
Prefix:
First Name:VIVIENNE
Middle Name:
Last Name:YAKUM
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:VIVIENNE
Other - Middle Name:
Other - Last Name:AKUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2000 HOWARD FARM DR STE 450
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-6085
Mailing Address - Country:US
Mailing Address - Phone:404-962-6000
Mailing Address - Fax:404-962-6001
Practice Address - Street 1:2000 HOWARD FARM DR STE 450
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-6085
Practice Address - Country:US
Practice Address - Phone:404-962-6000
Practice Address - Fax:404-962-6001
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10576363A00000X
NY005268363AS0400X
NJ25MP00198300363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY005268Medicaid
NY5717L1Medicare PIN