Provider Demographics
NPI:1407870702
Name:YOUNG, CARLTON
Entity Type:Individual
Prefix:
First Name:CARLTON
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1717 6TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1801
Practice Address - Country:US
Practice Address - Phone:800-822-8816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21037208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0000189969OtherBLUE CROSS
MS00122977OtherMISSISSIPPI MEDICAID
AL000018996Medicaid
AL009971980Medicaid
ALF77041OtherVIVA
AL000034895OtherBLUE CROSS
AL051504810OtherBLUE CROSS
MS00126985OtherMISSISSIPPI MEDICAID
AL000034895Medicaid
AL0000189969OtherBLUE CROSS
AL020035401Medicare PIN
AL000034895Medicare PIN