MEDICARE: YOUNG-JAE NAM MD

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
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207RC0000X	Cardiovascular Disease Physician	MD50902	TN
3	207RC0000X	Cardiovascular Disease Physician	93922	GA

General Provider Information

NPI Number	:	1952501405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YOUNG-JAE NAM MD

Provider Business Mailing Address
First Line	:	3841 GREEN HILLS VILLAGE DR STE 200
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-2691
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2151 W SPRING ST STE B220
Second Line	:
City	:	MONROE
State	:	GA
Zip	:	30655-3215
Country	:	US
Telephone Number	:	770-267-1895
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2007
Last Update Date	:	01/25/2023

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