Provider Demographics
NPI:1396832150
Name:YOUNG, WILLIAM DANIEL (MD)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:DANIEL
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 MATTHEW DR STE 7
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:MS
Mailing Address - Zip Code:39367-2573
Mailing Address - Country:US
Mailing Address - Phone:601-735-0077
Mailing Address - Fax:601-735-3937
Practice Address - Street 1:940 MATTHEW DR STE 7
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:MS
Practice Address - Zip Code:39367
Practice Address - Country:US
Practice Address - Phone:601-735-0077
Practice Address - Fax:601-735-3937
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS04733174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00111416Medicaid
MSC48397Medicare UPIN
MS00111416Medicaid