Healthcare Provider Details

I. General information

NPI: 1033726179
Provider Name (Legal Business Name): YOUNG HEALTHCARE ASSOCIATES & CO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2020
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3755 MAIN ST UNIT 101
COLLEGE PARK GA
30337-3543
US

IV. Provider business mailing address

390 DARIEN DR
SENOIA GA
30276-3609
US

V. Phone/Fax

Practice location:
  • Phone: 678-632-5331
  • Fax: 551-214-0934
Mailing address:
  • Phone: 678-357-2682
  • Fax: 551-214-0934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. SHANTE NICOLE YOUNG
Title or Position: CEO
Credential: DNP, FNP-C, PMHNP-BC
Phone: 678-632-5331