Provider Demographics
NPI:1033210521
Name:DR. JUDITH S. YONGUE
Entity Type:Organization
Organization Name:DR. JUDITH S. YONGUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:W
Authorized Official - Last Name:GILLIKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MBA
Authorized Official - Phone:252-353-7162
Mailing Address - Street 1:PO BOX 30696
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27833-0696
Mailing Address - Country:US
Mailing Address - Phone:252-353-7162
Mailing Address - Fax:252-353-1760
Practice Address - Street 1:107 COMMERCE ST
Practice Address - Street 2:D
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5027
Practice Address - Country:US
Practice Address - Phone:252-355-2768
Practice Address - Fax:252-355-0403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC135422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8989714Medicaid
NC8989714Medicaid
NCC81344Medicare UPIN