MEDICARE: DWAYNE LAMONT YOUNGER

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	347C00000X	Private Vehicle	T62202755	VA

General Provider Information

NPI Number	:	1174163760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DWAYNE LAMONT YOUNGER

Provider Business Mailing Address
First Line	:	1150 BLUE ROCK RD
Second Line	:
City	:	VERNON HILL
State	:	VA
Zip	:	24597-3091
Country	:	US
Telephone Number	:	434-222-8894
Fax Number	:	434-476-1539

Provider Business Practice Location Address
First Line	:	1150 BLUE ROCK RD
Second Line	:
City	:	VERNON HILL
State	:	VA
Zip	:	24597-3091
Country	:	US
Telephone Number	:	434-222-8894
Fax Number	:	434-476-1539

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

Provider Enumeration Date	:	01/10/2020
Last Update Date	:	01/10/2020

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Directions to “ DWAYNE LAMONT YOUNGER ” Practice Location

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