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General NPI Number Information
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NPI Number | 1245735349
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Entity Type | Organization
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Legal Business Name | J. SHAN YOUNG, MD LLC
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Dates
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Enumeration Date | 03/29/2018
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Last Update Date | 03/29/2018
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Provider Practice Location Address
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Address Line | 409 E 10TH ST
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City | ANNISTON
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State | AL
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Zip | 36207-4780
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Country | US
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Telephone | 256-435-1399
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Fax | 256-435-1911
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Provider Business Mailing Address
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Address Line | PO BOX 8061
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City | ANNISTON
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State | AL
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Zip | 36202-8061
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Country | US
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Telephone | 256-435-1399
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Fax | 256-435-1911
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CYNTHIA B YOUNG
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Credential | RN
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Telephone | 256-435-1399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 15920
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License Number State | AL
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