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General NPI Number Information
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NPI Number | 1093063380
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Entity Type | Individual
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Provider Name | JENNIFER ELLEN YOUNG MSM, PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/17/2012
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 1800 HOWELL MILL RD NW STE 500
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City | ATLANTA
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State | GA
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Zip | 30318-2594
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Country | US
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Telephone | 404-367-3350
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Fax |
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Provider Business Mailing Address
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Address Line | 2227 PLANTATION DR
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City | EAST POINT
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State | GA
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Zip | 30344-2118
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Country | US
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Telephone | 615-513-7804
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA07823
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 8327
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License Number State | GA
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