# CLINIC AT C. C. YOUNG

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- **Entity:** Organization
- **Status:** Active
- **Other names:** COMMUNITY CLINIC AT C. C. YOUNG
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104371442
- **Authorized official:** RUSSELL CREWS (PRESIDENT/CEO)
- **Authorized official phone:** (214) 841-2819

## Contact information

- **Practice address:** 4829 W LAWTHER DR, DALLAS, TX 75214-1858
- **Practice address phone:** (972) 432-7874
- **Mailing address:** 4847 W LAWTHER DR, SUITE 100, DALLAS, TX 75214-1853
- **Mailing address phone:** (214) 827-8080

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0505X | Adult Medicine Physician | 645300 | TX | Yes |

## Other

- **Enumeration date:** 08/16/2016
- **Last updated:** 08/16/2016