Healthcare Provider Details

I. General information

NPI: 1699705103
Provider Name (Legal Business Name): SCOTT A YOUNG PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 CALHOUN ST
CHARLESTON SC
29401-1113
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 843-724-2000
  • Fax: 843-805-6277
Mailing address:
  • Phone: 704-384-9200
  • Fax: 704-384-6588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number102612
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberTL1317
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: