Provider Demographics
NPI:1558317412
Name:YOUNG, ERIN H (AAC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:H
Last Name:YOUNG
Suffix:
Gender:F
Credentials:AAC
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1076
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-1076
Mailing Address - Country:US
Mailing Address - Phone:770-532-7179
Mailing Address - Fax:770-534-1312
Practice Address - Street 1:743 SPRING ST NE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3715
Practice Address - Country:US
Practice Address - Phone:770-532-7179
Practice Address - Fax:770-534-1312
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA003509367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100002124BMedicaid
GA100002124CMedicaid
GAP32012Medicare UPIN
GA100002124CMedicaid