Provider Demographics
NPI:1013563139
Name:YOUNG, BRIAN CLAY (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:CLAY
Last Name:YOUNG
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7351 OLD MOON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-7291
Mailing Address - Country:US
Mailing Address - Phone:706-653-7000
Mailing Address - Fax:706-653-7800
Practice Address - Street 1:638 LEE ROAD 483
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36804-1773
Practice Address - Country:US
Practice Address - Phone:770-547-3632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN158039363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN158039OtherSTATE LICENSE