Healthcare Provider Details

I. General information

NPI: 1023972536
Provider Name (Legal Business Name): JONATHAN BRANDON YOUNG BPS, CPRS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 ANNIE RUSS RD
MEDINA TN
38355-9743
US

IV. Provider business mailing address

50 ANNIE RUSS RD
MEDINA TN
38355-9743
US

V. Phone/Fax

Practice location:
  • Phone: 737-314-3153
  • Fax:
Mailing address:
  • Phone: 737-314-3153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number000-1828
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: