Provider Demographics
NPI:1053986174
Name:RAWLS, YOLONDA MICHELLE
Entity type:Individual
Prefix:
First Name:YOLONDA
Middle Name:MICHELLE
Last Name:RAWLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2774 COBB PKWY NW STE 109
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-3497
Mailing Address - Country:US
Mailing Address - Phone:770-866-1777
Mailing Address - Fax:
Practice Address - Street 1:149 PARKMONT COURT
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132
Practice Address - Country:US
Practice Address - Phone:770-866-1777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-21
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN205166363L00000X
TX1045202363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner