Provider Demographics
NPI:1285276055
Name:DVINE, YAUNTE
Entity type:Individual
Prefix:
First Name:YAUNTE
Middle Name:
Last Name:DVINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 MACON ST STE D
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-3233
Mailing Address - Country:US
Mailing Address - Phone:678-722-3357
Mailing Address - Fax:678-831-3554
Practice Address - Street 1:40 MACON ST STE D
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-3233
Practice Address - Country:US
Practice Address - Phone:678-722-3357
Practice Address - Fax:678-831-3554
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246YC3302XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health InformationCoding Specialist, Physician Office Based