Individual
ELAINE C YOUNGBLOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1045 SOUTHCREST DR, STE 110, STOCKBRIDGE, GA 30281
(770) 507-2212
(770) 507-2213
Mailing address
1045 SOUTHCREST DR, STE 110, STOCKBRIDGE, GA 30281
(770) 507-2212
(770) 507-2213
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
043513
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000756599C
—
GA
01
—
52671130
BCBS
GA
Enumeration date
06/13/2006
Last updated
01/30/2013
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