MEDICARE: MR. JONATHAN JOEL YOUNG PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	5601005796	MI
2	363A00000X	Physician Assistant	1686	SC

General Provider Information

NPI Number	:	1093026536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JONATHAN JOEL YOUNG PA-C

Provider Business Mailing Address
First Line	:	PO BOX 50520
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29485-0520
Country	:	US
Telephone Number	:	843-552-4240
Fax Number	:	843-552-4121

Provider Business Practice Location Address
First Line	:	1101 BOWMAN RD
Second Line	:
City	:	MT PLEASANT
State	:	SC
Zip	:	29464-3213
Country	:	US
Telephone Number	:	843-552-4240
Fax Number	:	843-552-4121

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2010
Last Update Date	:	03/15/2013

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