Healthcare Provider Details

I. General information

NPI: 1932693280
Provider Name (Legal Business Name): EVERETT GLENN YOUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2018
Last Update Date: 07/23/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1272 VIRGIL LANGFORD RD
WATKINSVILLE GA
30677-7245
US

IV. Provider business mailing address

1272 VIRGIL LANGFORD RD
ATHENS GA
30606
US

V. Phone/Fax

Practice location:
  • Phone: 770-292-6500
  • Fax: 770-292-6535
Mailing address:
  • Phone: 770-758-7903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberTRN27081
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD481748
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number99894
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: