Provider Demographics
NPI:1124005897
Name:YOUNG, CAROL RAY JR (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:RAY
Last Name:YOUNG
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936857
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-6857
Mailing Address - Country:US
Mailing Address - Phone:910-721-4390
Mailing Address - Fax:910-721-4399
Practice Address - Street 1:512 VILLAGE RD STE 101
Practice Address - Street 2:
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470-3409
Practice Address - Country:US
Practice Address - Phone:910-721-4390
Practice Address - Fax:910-721-4399
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC32308207RP1001X
VA0101050316207RP1001X
NC9801123207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN01124Medicaid
NC891220NMedicaid
SCGP3912OtherMEDICAID GROUP
SCGP4306OtherMEDICAID GROUP
SCN01124Medicaid
NC891220NMedicaid
SCN01124Medicaid