Provider Demographics
NPI:1245735349
Name:J. SHAN YOUNG, MD LLC
Entity Type:Organization
Organization Name:J. SHAN YOUNG, MD LLC
Other - Org Name:J. SHAN YOUNG, MD LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:256-435-1399
Mailing Address - Street 1:PO BOX 8061
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36202-8061
Mailing Address - Country:US
Mailing Address - Phone:256-435-1399
Mailing Address - Fax:256-435-1911
Practice Address - Street 1:409 E 10TH ST
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-4780
Practice Address - Country:US
Practice Address - Phone:256-435-1399
Practice Address - Fax:256-435-1911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15920207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty