Healthcare Provider Details

I. General information

NPI: 1285675348
Provider Name (Legal Business Name): PHILIP C YOUNT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 MEDICAL PARK DRIVE
JEFFERSON NC
28640
US

IV. Provider business mailing address

100 KIMEL FOREST DR
WINSTON SALEM NC
27103-6074
US

V. Phone/Fax

Practice location:
  • Phone: 336-246-7161
  • Fax: 336-246-6183
Mailing address:
  • Phone: 336-716-1331
  • Fax: 336-716-3202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number31941
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: