Basic Information
| Provider Information | |||||||||
| NPI: | 1447250873 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YEAGER | ||||||||
| FirstName: | RENATA | ||||||||
| MiddleName: | W. | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RNFA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HURST | ||||||||
| OtherFirstName: | RENATA | ||||||||
| OtherMiddleName: | W. | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | RNFA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7001 HODGSON MEMORIAL DR | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314062549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123546303 | ||||||||
| FaxNumber: | 9123558655 | ||||||||
| Practice Location | |||||||||
| Address1: | 7001 HODGSON MEMORIAL DR | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314062549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123546303 | ||||||||
| FaxNumber: | 9123558655 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | X | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WM0705X | RN077776 | GA | Y | Nursing Service Providers | Registered Nurse | Medical-Surgical |
ID Information
| ID | Type | State | Issuer | Description | 100231 | 01 | GA | BCBS | OTHER |