Healthcare Provider Details

I. General information

NPI: 1447894092
Provider Name (Legal Business Name): CLAIRE-LOUISE SOPHIA YOUNG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2019
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date: 12/08/2020
Reactivation Date: 06/22/2021

III. Provider practice location address

1200 MEMORIAL DR
DALTON GA
30720-2529
US

IV. Provider business mailing address

1200 MEMORIAL DR
DALTON GA
30720-2529
US

V. Phone/Fax

Practice location:
  • Phone: 706-272-6000
  • Fax: 816-404-0003
Mailing address:
  • Phone: 706-272-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number2019045193
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: