Healthcare Provider Details

I. General information

NPI: 1093063380
Provider Name (Legal Business Name): JENNIFER ELLEN YOUNG MSM, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2012
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 HOWELL MILL RD NW STE 500
ATLANTA GA
30318-2594
US

IV. Provider business mailing address

2227 PLANTATION DR
EAST POINT GA
30344-2118
US

V. Phone/Fax

Practice location:
  • Phone: 404-367-3350
  • Fax:
Mailing address:
  • Phone: 615-513-7804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA07823
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8327
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: