Provider Demographics
NPI:1699720052
Name:HERMONI, YITZCHAK (MD)
Entity type:Individual
Prefix:
First Name:YITZCHAK
Middle Name:
Last Name:HERMONI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 BALD RIDGE MARINA RD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-8494
Mailing Address - Country:US
Mailing Address - Phone:770-886-0003
Mailing Address - Fax:770-886-5030
Practice Address - Street 1:1200 BALD RIDGE MARINA RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-8494
Practice Address - Country:US
Practice Address - Phone:770-886-0003
Practice Address - Fax:770-886-5030
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033352207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00446025EMedicaid
5994428OtherAETNA
02500011OtherUNITED HEALTHCARE
686997OtherBCBS OF ALABAMA
1396339-005OtherCIGNA
545418OtherBLUE CROSS BLUE SHIELD
686997OtherBCBS OF ALABAMA
A82238Medicare UPIN