Organization
GEORGIA DEPT. OF CORRECTIONS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY YOUNG M.D. (CLINIC DIRECTOR)
(706) 855-4833
Entity
Organization
Contact information
Practice address
3001 GORDON HWY, GROVETOWN, GA 30813-3808
(706) 855-4984
Mailing address
645 SIMONTON CREST DR, LAWRENCEVILLE, GA 30045-3512
(770) 377-6580
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
2678
GA
Other
Enumeration date
05/21/2015
Last updated
05/21/2015
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