Provider Demographics
NPI:1215308028
Name:YADAV, LILY (NP-C)
Entity type:Individual
Prefix:MRS
First Name:LILY
Middle Name:
Last Name:YADAV
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 SAVOY DR STE 300
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-1071
Mailing Address - Country:US
Mailing Address - Phone:404-256-4777
Mailing Address - Fax:404-256-5515
Practice Address - Street 1:1501 MILSTEAD RD NE STE 110
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3849
Practice Address - Country:US
Practice Address - Phone:770-760-9949
Practice Address - Fax:770-760-9951
Is Sole Proprietor?:No
Enumeration Date:2015-10-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN252873363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA20250I1992OtherMEDICARE PTAN
GA003169065BMedicaid
GA003169065CMedicaid