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General NPI Number Information
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NPI Number | 1588902076
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Entity Type | Individual
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Provider Name | MR. UMAR DONTAY YOUNG SR.
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Gender | Male
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Dates
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Enumeration Date | 01/18/2013
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Last Update Date | 01/18/2013
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Provider Practice Location Address
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Address Line | 7400 POWERS AVE APT 370
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City | JACKSONVILLE
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State | FL
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Zip | 32217-3943
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Country | US
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Telephone | 904-517-7970
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Fax | 904-213-0835
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Provider Business Mailing Address
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Address Line | 7400 POWERS AVE APT 370
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City | JACKSONVILLE
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State | FLA
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Zip | 32217
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Country | UM
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Telephone | 904-517-7970
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Fax | 904-213-0835
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State | FL
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