Provider Demographics
NPI:1538229679
Name:DAMIS, YVES LAURE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:YVES LAURE
Middle Name:
Last Name:DAMIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 SUMMIT CROSSING PL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2138
Mailing Address - Country:US
Mailing Address - Phone:704-671-5400
Mailing Address - Fax:704-671-5420
Practice Address - Street 1:1918 RANDOLPH RD STE 400
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1196
Practice Address - Country:US
Practice Address - Phone:704-384-9437
Practice Address - Fax:704-384-9440
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051464363AM0700X
PAOA000867363AM0700X
NY014480363AM0700X
CT2509363AM0700X
NC0010-05119363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD1138292OtherDEA
PAMD1138292OtherDEA