Provider Demographics
NPI:1275203689
Name:YOUMANS, JACOB TAYLOR (CRNA)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:TAYLOR
Last Name:YOUMANS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:JACOB
Other - Middle Name:TAYLOR JOE
Other - Last Name:YOUMANS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 945375
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30394-5375
Mailing Address - Country:US
Mailing Address - Phone:516-945-3000
Mailing Address - Fax:704-248-5537
Practice Address - Street 1:247 S MAIN ST
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30453-4605
Practice Address - Country:US
Practice Address - Phone:516-945-3000
Practice Address - Fax:704-248-5537
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GANCO-000002367500000X
GARN254883367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered