Provider Demographics
NPI:1306869375
Name:YATES, ERICA LYNN (MD)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:LYNN
Last Name:YATES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1390
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38835-1390
Mailing Address - Country:US
Mailing Address - Phone:662-287-6999
Mailing Address - Fax:662-287-1709
Practice Address - Street 1:2000 SHILOH ROAD
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-2909
Practice Address - Country:US
Practice Address - Phone:662-287-6999
Practice Address - Fax:662-287-1709
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16082207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00119928Medicaid
G79757Medicare UPIN
MS080004093Medicare ID - Type Unspecified