Individual
STEPHANIE P YOUNG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
117 WEST NORTHSIDE DRIVE, VALDOSTA, GA 31602
(229) 242-6061
(229) 242-6151
Mailing address
117 WEST NORTHSIDE DRIVE, VALDOSTA, GA 31602
(229) 242-6061
(229) 242-6151
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
004092
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
340568313B
—
GA
05
—
340568313D
—
GA
Enumeration date
06/28/2006
Last updated
10/03/2013
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