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General NPI Number Information
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NPI Number | 1699484667
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Entity Type | Organization
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Legal Business Name | YOUNG PROFESSIONAL CONSULTING LLC
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Dates
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Enumeration Date | 11/18/2022
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Last Update Date | 01/10/2024
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Provider Practice Location Address
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Address Line | 3100 FIVE FORKS TRICKUM RD SW STE 503
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City | LILBURN
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State | GA
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Zip | 30047-1888
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Country | US
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Telephone | 678-909-9035
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Fax |
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Provider Business Mailing Address
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Address Line | 1450 W PEACHTREE ST. NW 200 UNITE 25349
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City | ATLANTA
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State | GA
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Zip | 30309
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Country | US
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Telephone | 678-909-9035
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Fax |
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Authorized Official
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Title or Position | CNO
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Name | TASHA YOUNG
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Credential | RN
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Telephone | 678-909-9035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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