=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851302129
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHERYL L . HOWARD YOUNG, DO, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2006
-----------------------------------------------------
Last Update Date | 04/08/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 308 NORTH DAVIS DR
-----------------------------------------------------
City | WARNER ROBINS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31093
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-929-0068
-----------------------------------------------------
Fax | 478-929-1238
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 308 N DAVIS DR
-----------------------------------------------------
City | WARNER ROBINS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31093-3350
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-929-0068
-----------------------------------------------------
Fax | 478-929-1238
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CHERYL L YOUNG
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 478-929-0068
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 051574
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------