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General NPI Number Information
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NPI Number | 1811389869
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Entity Type | Individual
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Provider Name | SHANTE NICOLE YOUNG DNP
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Gender | Female
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Dates
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Enumeration Date | 02/27/2015
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 1751 NEWNAN CROSSING BLVD E
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City | NEWNAN
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State | GA
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Zip | 30265-1517
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Country | US
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Telephone | 678-423-5854
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 932958
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City | CLEVELAND
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State | OH
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Zip | 44193-0028
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Country | US
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Telephone |
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Fax | 551-214-0934
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN192017
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN192017
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | RN192017
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License Number State | GA
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