Individual
CHARLES D YEARTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
705 DIXIE ST, CARROLLTON, GA 30117-3818
(770) 836-9666
(770) 836-9212
Mailing address
POST OFFICE BOX 235019, MONTGOMERY, AL 36177-8045
(770) 812-5730
(770) 838-8563
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
1-037195
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
051526410
—
AL
01
—
51526410
BLUE SHIELD
AL
01
—
P00197496
PALMETTO GBA
AL
Enumeration date
05/06/2006
Last updated
07/01/2010
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