Provider Demographics
NPI:1083239545
Name:YOUNG, JOHANNA C (PA-C)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:C
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:103 MCALPINE LN # A
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28352-4637
Mailing Address - Country:US
Mailing Address - Phone:910-277-7546
Mailing Address - Fax:910-277-0048
Practice Address - Street 1:103 MCALPINE LN # A
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-4637
Practice Address - Country:US
Practice Address - Phone:910-277-7546
Practice Address - Fax:910-277-0048
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-10212363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant