Healthcare Provider Details

I. General information

NPI: 1295086999
Provider Name (Legal Business Name): JOSHUA SHANE YOUNG N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2012
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1157 FORSYTH ST STE 200
MACON GA
31201-7454
US

IV. Provider business mailing address

1157 FORSYTH ST STE 200
MACON GA
31201-7454
US

V. Phone/Fax

Practice location:
  • Phone: 478-476-1968
  • Fax: 877-673-2540
Mailing address:
  • Phone: 478-478-1968
  • Fax: 877-673-2540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN173347
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: