Provider Demographics
NPI:1487735403
Name:YAMADA, MICHELLE M (PA)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:M
Last Name:YAMADA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 FREDERICK STREET
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4501
Mailing Address - Country:US
Mailing Address - Phone:912-351-3030
Mailing Address - Fax:912-351-3039
Practice Address - Street 1:5201 FREDERICK STREET
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4501
Practice Address - Country:US
Practice Address - Phone:912-351-3030
Practice Address - Fax:912-351-3039
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4303207Y00000X, 363A00000X
GA004303207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA275998532AMedicaid
GA344049OtherMEDICAID WELLCARE HMO #
GA97WCGRNMedicare ID - Type Unspecified