Provider Demographics
NPI:1508542549
Name:YOUNG, ROY J (CPS-MH,AD CARES)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:J
Last Name:YOUNG
Suffix:
Gender:M
Credentials:CPS-MH,AD CARES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1297 BURNETT FERRY RD SW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-8515
Mailing Address - Country:US
Mailing Address - Phone:603-948-5440
Mailing Address - Fax:
Practice Address - Street 1:1297 BURNETT FERRY RD SW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-8515
Practice Address - Country:US
Practice Address - Phone:603-948-5440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist