Provider Demographics
NPI:1588097612
Name:YU, FANG HELEN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:FANG
Middle Name:HELEN
Last Name:YU
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:HELEN
Other - Middle Name:
Other - Last Name:YU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:114 TOWNPARK DR NW
Mailing Address - Street 2:SUITE 240
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-3715
Mailing Address - Country:US
Mailing Address - Phone:770-952-8612
Mailing Address - Fax:678-803-6944
Practice Address - Street 1:1240 HIGHWAY 54 W
Practice Address - Street 2:BUILDING 300, SUITE 310
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4557
Practice Address - Country:US
Practice Address - Phone:770-461-6400
Practice Address - Fax:770-460-2941
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN188712363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003140290CMedicaid
GA20250I1934OtherMEDICARE