Provider Demographics
NPI:1043519622
Name:YOUNG, NORMA SHIVER
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:SHIVER
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2435 JEFFERSON RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30607-1202
Mailing Address - Country:US
Mailing Address - Phone:706-549-8598
Mailing Address - Fax:706-353-0689
Practice Address - Street 1:2435 JEFFERSON RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30607-1202
Practice Address - Country:US
Practice Address - Phone:706-549-8598
Practice Address - Fax:706-353-0689
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA016683183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist