Healthcare Provider Details

I. General information

NPI: 1932166329
Provider Name (Legal Business Name): STEWART GREGORY YOUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 05/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2406 DECKER BLVD
COLUMBIA SC
29206-2362
US

IV. Provider business mailing address

PO BOX 402145
ATLANTA GA
30384-2145
US

V. Phone/Fax

Practice location:
  • Phone: 803-736-2530
  • Fax: 803-736-4830
Mailing address:
  • Phone: 803-296-7305
  • Fax: 803-296-7330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12878
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: