Provider Demographics
NPI:1366857807
Name:YOUNG, ROBERT ADAM (OD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ADAM
Last Name:YOUNG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:2730 PEACHTREE INDUSTRIAL BLVD STE 206
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-8628
Mailing Address - Country:US
Mailing Address - Phone:404-793-3937
Mailing Address - Fax:404-793-4040
Practice Address - Street 1:2730 PEACHTREE INDUSTRIAL BLVD STE 206
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-8628
Practice Address - Country:US
Practice Address - Phone:404-793-3937
Practice Address - Fax:404-793-4040
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002818152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist