Healthcare Provider Details

I. General information

NPI: 1699484667
Provider Name (Legal Business Name): YOUNG PROFESSIONAL CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2022
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 FIVE FORKS TRICKUM RD SW STE 503
LILBURN GA
30047-1888
US

IV. Provider business mailing address

1450 W PEACHTREE ST. NW 200 UNITE 25349
ATLANTA GA
30309
US

V. Phone/Fax

Practice location:
  • Phone: 678-909-9035
  • Fax:
Mailing address:
  • Phone: 678-909-9035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TASHA YOUNG
Title or Position: CNO
Credential: RN
Phone: 678-909-9035