Provider Demographics
NPI:1134297575
Name:YOUNG, DANIEL M (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:M
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2011 COMMERCE DR N STE 25
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-3538
Mailing Address - Country:US
Mailing Address - Phone:844-994-6633
Mailing Address - Fax:
Practice Address - Street 1:2011 COMMERCE DR N STE 25
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-3538
Practice Address - Country:US
Practice Address - Phone:844-994-6633
Practice Address - Fax:470-235-1861
Is Sole Proprietor?:No
Enumeration Date:2006-12-02
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005016363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA825860677AMedicaid
GA825860677CMedicaid
GA825860677BMedicaid
GA825860677AMedicaid
GAQ77030Medicare UPIN