Healthcare Provider Details

I. General information

NPI: 1215676614
Provider Name (Legal Business Name): REBECCA YOUNG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2022
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5353 REYNOLDS ST
SAVANNAH GA
31405-6015
US

IV. Provider business mailing address

3 CHIPPER CIR
SAVANNAH GA
31406-2013
US

V. Phone/Fax

Practice location:
  • Phone: 912-819-6000
  • Fax:
Mailing address:
  • Phone: 706-207-1723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number248330
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN248330
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: