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General NPI Number Information
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NPI Number | 1659477404
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Entity Type | Organization
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Legal Business Name | CORDELE FAMILY MEDICINE PC
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 501 THIRD AVENUE EAST
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City | CORDELE
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State | GA
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Zip | 31015
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Country | US
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Telephone | 229-273-0841
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Fax | 229-273-0841
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Provider Business Mailing Address
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Address Line | 501 THIRD AVENUE EAST
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City | CORDELE
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State | GA
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Zip | 31015
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Country | US
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Telephone | 229-273-0841
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Fax | 229-273-0758
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MR. HENRY WILLIAM YOUNG
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Credential | MD
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Telephone | 229-273-0841
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 22921
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License Number State | GA
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