Basic Information
| Provider Information | |||||||||
| NPI: | 1356323273 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YADAO | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3495 PIEDMONT ROAD, NE | ||||||||
| Address2: | NINE PIEDMONT CENTER | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043647070 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5440 HILLANDALE DRIVE | ||||||||
| Address2: | KAISER PERMANENTE PANOLA MEDICAL OFFICE | ||||||||
| City: | LITHONIA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7703222712 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2005 | ||||||||
| LastUpdateDate: | 04/07/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 2003012665 | MO | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 063553 | GA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 1201961 | 01 | MS | UHC | OTHER | 431383893YAD | 01 | MO | MERCY | OTHER | 663444 | 01 | MO | HEALTHLINK | OTHER | 7446562 | 01 | MO | AETNA | OTHER | 190566 | 01 | MO | BCBS | OTHER | 50312V3431 | 01 | MO | HEALTHCARE USA | OTHER | 216125 | 01 | MO | GHP | OTHER |