Healthcare Provider Details

I. General information

NPI: 1669464137
Provider Name (Legal Business Name): GEORGE CLIFTON YOUNG SR. A.T.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 N I-35
DENTON TX
76201-5119
US

IV. Provider business mailing address

3822 WATERFORD WAY
DENTON TX
76210-8812
US

V. Phone/Fax

Practice location:
  • Phone: 940-898-7166
  • Fax: 940-898-7311
Mailing address:
  • Phone: 940-484-7261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT0117
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: