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General NPI Number Information
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NPI Number | 1164961629
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Entity Type | Individual
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Provider Name | SHANNON JOHNSON YOUNGER PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/16/2017
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Last Update Date | 04/24/2020
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Provider Practice Location Address
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Address Line | 724 LEIGH DR
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City | COLUMBUS
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State | MS
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Zip | 39705-3098
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Country | US
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Telephone | 662-328-3375
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Fax | 662-328-3395
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Provider Business Mailing Address
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Address Line | 724 LEIGH DR
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City | COLUMBUS
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State | MS
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Zip | 39705-3098
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Country | US
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Telephone | 662-328-3375
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Fax | 662-328-3395
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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 | PA9110198
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License Number State | FL
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