Healthcare Provider Details

I. General information

NPI: 1366487365
Provider Name (Legal Business Name): DAVID RUSSELL YOUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 LAKELAND DR SUITE 61
JACKSON MS
39216-4635
US

IV. Provider business mailing address

970 LAKELAND DR STE 40
JACKSON MS
39216-4640
US

V. Phone/Fax

Practice location:
  • Phone: 601-982-7850
  • Fax: 601-718-5145
Mailing address:
  • Phone: 601-982-7850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number13925
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number13925
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: