Individual
GAVAN W YATES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
2232 WILBORN AVE STE C, SOUTH BOSTON, VA 24592-1662
(434) 517-3910
Mailing address
2232 WILBORN AVE STE C, SOUTH BOSTON, VA 24592-1662
(434) 517-3910
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110008467
VA
Other
Enumeration date
05/24/2021
Last updated
07/22/2022
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