Provider Demographics
NPI:1841317336
Name:RONALD B. YANCEY, P.C.
Entity type:Organization
Organization Name:RONALD B. YANCEY, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-537-4400
Mailing Address - Street 1:303 HARRIS INDUSTRIAL BLVD.
Mailing Address - Street 2:SUITE 7
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-4752
Mailing Address - Country:US
Mailing Address - Phone:912-537-4400
Mailing Address - Fax:912-537-4233
Practice Address - Street 1:303 HARRIS INDUSTRIAL BLVD.
Practice Address - Street 2:SUITE 7
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-4752
Practice Address - Country:US
Practice Address - Phone:912-537-4400
Practice Address - Fax:912-537-4233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1357T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00514621DMedicaid
GA41ZCFGBMedicare ID - Type UnspecifiedGROUP #