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NPI Code Detail

MEDICARE: MS. JENNIFER ELLEN YOUNG MSM, PA-C

MEDICARE: MS. JENNIFER ELLEN YOUNG MSM, PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician AssistantPA07823TX
2363A00000XPhysician Assistant8327GA

General Provider Information

NPI Number : 1093063380
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JENNIFER ELLEN YOUNG MSM, PA-C
Provider Business Mailing Address
First Line : 2227 PLANTATION DR
Second Line :
City : EAST POINT
State : GA
Zip : 30344-2118
Country : US
Telephone Number : 615-513-7804
Fax Number :
Provider Business Practice Location Address
First Line : 1800 HOWELL MILL RD NW STE 500
Second Line :
City : ATLANTA
State : GA
Zip : 30318-2594
Country : US
Telephone Number : 404-367-3350
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2012
Last Update Date : 05/14/2025

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