Provider Demographics
NPI:1285431767
Name:YANKEN, MAXWELL ALLEN
Entity type:Individual
Prefix:
First Name:MAXWELL
Middle Name:ALLEN
Last Name:YANKEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:569 TURKEY CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-2099
Mailing Address - Country:US
Mailing Address - Phone:478-484-1661
Mailing Address - Fax:
Practice Address - Street 1:1689 OLD PENDERGRASS RD STE 310
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:GA
Practice Address - Zip Code:30549-2716
Practice Address - Country:US
Practice Address - Phone:706-367-0010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program