Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 14971 | MS |
NPI | 1013911668 |
---|---|
Provider Name | Tammy H Young |
First Address | Jackson, MS 39202-2002 |
Second Address | Jackson, MS 39202-2002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2005 |
Last Update Date | 27/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00125697 | (05) | MS |
7435369 | AETNA HEALTHCARE (01) | |
H62261 | (02) |