Provider Demographics
NPI:1497857718
Name:PIEDMONT PROSTATE CENTER, PLLC
Entity type:Organization
Organization Name:PIEDMONT PROSTATE CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:YATWAH
Authorized Official - Middle Name:
Authorized Official - Last Name:LEUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-889-9555
Mailing Address - Street 1:PO BOX 5109
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-5109
Mailing Address - Country:US
Mailing Address - Phone:336-889-9555
Mailing Address - Fax:336-887-1339
Practice Address - Street 1:218 GATEWOOD AVE
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4877
Practice Address - Country:US
Practice Address - Phone:336-889-9555
Practice Address - Fax:336-887-1339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891263VMedicaid
NC891263VMedicaid
NCG12267Medicare UPIN