Healthcare Provider Details

I. General information

NPI: 1184467581
Provider Name (Legal Business Name): LOGAN ELIZABETH YOUNG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 N DRUID HILLS RD NE
ATLANTA GA
30329-3117
US

IV. Provider business mailing address

465 MEMORIAL DR SE UNIT 581
ATLANTA GA
30312-2281
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-6712
  • Fax:
Mailing address:
  • Phone: 864-561-4331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number718222
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: