Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 023418 | GA |
NPI | 1518977701 |
---|---|
Provider Name | Dr. Timothy Richard Young |
First Address | Augusta, GA 30901-2602 |
Second Address | Augusta, GA 30904-6258 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 11/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D41983 | (02) | GA |