Healthcare Provider Details

I. General information

NPI: 1376552224
Provider Name (Legal Business Name): GEORGE YOUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 PRINCE AVE
ATHENS GA
30606-2797
US

IV. Provider business mailing address

PO BOX 7337
ATHENS GA
30604-7337
US

V. Phone/Fax

Practice location:
  • Phone: 706-543-3449
  • Fax: 706-543-5744
Mailing address:
  • Phone: 706-543-3449
  • Fax: 706-543-5744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number041039
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: