Provider Demographics
NPI:1306225057
Name:DREADEN, YOUNG (NP)
Entity Type:Individual
Prefix:
First Name:YOUNG
Middle Name:
Last Name:DREADEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:GDCP,P.O.BOX 3877
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:GA
Mailing Address - Zip Code:30233
Mailing Address - Country:US
Mailing Address - Phone:770-504-2112
Mailing Address - Fax:
Practice Address - Street 1:2978 HWY 36W
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:GA
Practice Address - Zip Code:30233
Practice Address - Country:US
Practice Address - Phone:770-504-2112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN 109306 NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily