Healthcare Provider Details

I. General information

NPI: 1427179084
Provider Name (Legal Business Name): MARY CAROL YOUNGINER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 05/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 W BOBO NEWSOM HWY
HARTSVILLE SC
29550-4710
US

IV. Provider business mailing address

3000 AERIAL CENTER PKWY #100
MORRISVILLE NC
27560-9132
US

V. Phone/Fax

Practice location:
  • Phone: 843-339-2100
  • Fax:
Mailing address:
  • Phone: 919-481-9989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-05607
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: