Individual
DR. WALTER FULLER YOUNG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2265 CASCADE RD SW, ATLANTA, GA 30311-2801
(404) 753-4753
(404) 753-4228
Mailing address
2265 CASCADE RD SW, ATLANTA, GA 30311-2801
(404) 753-4753
(404) 753-4228
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
007392
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00057153A
—
GA
Enumeration date
06/07/2007
Last updated
10/24/2008
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