Healthcare Provider Details

I. General information

NPI: 1669989000
Provider Name (Legal Business Name): CAITLIN C YOUNG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2018
Last Update Date: 05/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 ST. JOSEPH'S CANDLER DRIVE SUITE 200
POOLER GA
31322
US

IV. Provider business mailing address

836 E. 65TH STREET SUITE 20
SAVANNAH GA
31405
US

V. Phone/Fax

Practice location:
  • Phone: 912-748-1999
  • Fax: 912-748-3847
Mailing address:
  • Phone: 912-819-7878
  • Fax: 912-819-3555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN224811
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: