Provider Demographics
NPI:1326411174
Name:YOUNG, ELIZABETH M (PHD, RDN, LD, CLT)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:M
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PHD, RDN, LD, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4678 CHERRY WAY SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-4614
Mailing Address - Country:US
Mailing Address - Phone:770-364-2652
Mailing Address - Fax:
Practice Address - Street 1:4678 CHERRY WAY SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-4614
Practice Address - Country:US
Practice Address - Phone:770-364-2652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALD001959133V00000X
TXDT81569133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered