Healthcare Provider Details

I. General information

NPI: 1205994316
Provider Name (Legal Business Name): MARTIN STEVEN YOUNG CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

941 SPRING CREEK RD
CHATTANOOGA TN
37412-3909
US

IV. Provider business mailing address

2327 BENDING OAK DR
CHATTANOOGA TN
37421-1543
US

V. Phone/Fax

Practice location:
  • Phone: 423-894-7870
  • Fax:
Mailing address:
  • Phone: 423-499-9428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number996684
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: