Provider Demographics
NPI:1174635957
Name:YOUNG, TYE B (DO)
Entity Type:Individual
Prefix:
First Name:TYE
Middle Name:B
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-851-6033
Mailing Address - Fax:615-851-2018
Practice Address - Street 1:1067 RIVERFRONT PKWY STE 201
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402-2222
Practice Address - Country:US
Practice Address - Phone:423-954-7177
Practice Address - Fax:423-560-7177
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1371207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000099888OtherBCBS PIN
MT0145444OtherMDCD PIN
MTP00300358Medicare PIN
MT000084879Medicare PIN
MT000099888OtherBCBS PIN