Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 13238 | SC |
NPI | 1033133772 |
---|---|
Provider Name | Carole M. Young |
First Address | Georgetown, SC 29440-3227 |
Second Address | Georgetown, SC 29440-3227 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
132387 | (05) | SC |
B05858 | (02) | SC |