Provider Demographics
NPI:1437299773
Name:YOUNG, BARBAR A (PA)
Entity Type:Individual
Prefix:
First Name:BARBAR
Middle Name:A
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3290 MEMORIAL DR STE B3
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-3400
Mailing Address - Country:US
Mailing Address - Phone:404-534-9692
Mailing Address - Fax:404-534-9934
Practice Address - Street 1:3290 MEMORIAL DR STE B3
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-3400
Practice Address - Country:US
Practice Address - Phone:404-534-9692
Practice Address - Fax:404-534-9934
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002879363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGA LICENSEOther002879