Provider Demographics
NPI:1447264163
Name:ASA YANCY HEALTH CENTER
Entity type:Organization
Organization Name:ASA YANCY HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:SCHISSEL
Authorized Official - Suffix:
Authorized Official - Credentials:RN, PHD
Authorized Official - Phone:404-616-2265
Mailing Address - Street 1:1886 WINDEMERE DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-4918
Mailing Address - Country:US
Mailing Address - Phone:404-874-4609
Mailing Address - Fax:
Practice Address - Street 1:1247 DONALD LEE HOLLOWELL PKWY NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-6657
Practice Address - Country:US
Practice Address - Phone:404-616-2265
Practice Address - Fax:404-881-0622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAR042007261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center