Provider Demographics
NPI:1396833638
Name:KANAWATI, YASSAR JOMAH (MD)
Entity type:Individual
Prefix:MRS
First Name:YASSAR
Middle Name:JOMAH
Last Name:KANAWATI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:478 WOODLAWN DR NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-4022
Mailing Address - Country:US
Mailing Address - Phone:770-977-8954
Mailing Address - Fax:
Practice Address - Street 1:1720 PEACHTREE ST NW STE 320N
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-2449
Practice Address - Country:US
Practice Address - Phone:404-249-8496
Practice Address - Fax:404-249-8499
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0492372084P0802X, 2084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG19327Medicare UPIN