MEDICARE: YOUTH DEVELOPMENT CORPORATION OF AMERICA

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	251S00000X	Community/Behavioral Health Agency		GA

General Provider Information

NPI Number	:	1700094414
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUTH DEVELOPMENT CORPORATION OF AMERICA

Provider Business Mailing Address
First Line	:	6015 FAYETTEVILLE RD
Second Line	:	SUITE 211
City	:	DURHAM
State	:	NC
Zip	:	27713-6254
Country	:	US
Telephone Number	:	919-323-8081
Fax Number	:	919-572-0004

Provider Business Practice Location Address
First Line	:	2801 OLD DAWSON RD
Second Line	:	SUITE 200
City	:	ALBANY
State	:	GA
Zip	:	31707-1544
Country	:	US
Telephone Number	:	229-889-8884
Fax Number	:	229-889-8875

Authorized Official
Title or Position	:	DEVELOPMENT DIRECTOR
Name	:	SEAN SCHREIBER
Credential	:
Telephone Number	:	919-323-8081

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	08/22/2020

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Directions to “YOUTH DEVELOPMENT CORPORATION OF AMERICA ” Practice Location

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