Provider Demographics
NPI:1427269687
Name:WAJANAPONSAN, YAOWARAT (MD)
Entity type:Individual
Prefix:
First Name:YAOWARAT
Middle Name:
Last Name:WAJANAPONSAN
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 1:970 HUNTCLIFFE CT
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-7553
Mailing Address - Country:US
Mailing Address - Phone:808-352-8373
Mailing Address - Fax:478-474-4731
Practice Address - Street 1:560 1ST ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2824
Practice Address - Country:US
Practice Address - Phone:478-744-9603
Practice Address - Fax:478-744-9917
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-26
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMDR4794390200000X
GA061369207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program