Healthcare Provider Details

I. General information

NPI: 1689654014
Provider Name (Legal Business Name): LARRY CRESTON YOUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 10/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 23RD AVE NORTH SUITE 412
NASHVILLE TN
37203
US

IV. Provider business mailing address

345 23RD AVE NORTH SUITE 412
NASHVILLE TN
37203
US

V. Phone/Fax

Practice location:
  • Phone: 615-321-4545
  • Fax: 615-321-5565
Mailing address:
  • Phone: 615-321-4545
  • Fax: 615-321-5565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number011840
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: