Individual
HISA YAMAGUCHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1600 MEDICAL WAY STE 220, SNELLVILLE, GA 30078-2160
(770) 972-7999
(770) 972-9528
Mailing address
1600 MEDICAL WAY STE 220, SNELLVILLE, GA 30078-2160
(770) 972-7999
(770) 972-9528
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
37426
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000557675D
—
GA
05
—
00557675B
—
GA
01
—
020028724
RAILROAD MEDICARE
GA
Enumeration date
08/12/2005
Last updated
07/21/2022
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