Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | AT001757 | GA |
Y | 213ES0000X | Sports Medicine | AT001757 | GA |
NPI | 1184113342 |
---|---|
Provider Name | Mrs. Jamie Townsend Young |
First Address | Acworth, GA 30101-8800 |
Second Address | Kennesaw, GA 30144-7199 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2018 |
Last Update Date | 03/05/2018 |