Individual
JANE YAKLIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
413 W MONTGOMERY XRD STE 102, SAVANNAH, GA 31406-4321
(912) 354-4474
(912) 354-4443
Mailing address
413 W MONTGOMERY XRD STE 102, SAVANNAH, GA 31406-4321
(912) 354-4474
(912) 354-4443
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
1764
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000649569D
—
GA
05
—
003118497A
—
GA
01
—
10041028
AMERIGROUP CORPORATION
GA
01
—
344667
WELLCARE
GA
Enumeration date
12/05/2006
Last updated
01/29/2019
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