Provider Demographics
NPI:1598836173
Name:YOUNG, TIMOTHY AMES (MD)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:AMES
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:PO BOX 250029
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30325-1029
Mailing Address - Country:US
Mailing Address - Phone:404-351-5262
Mailing Address - Fax:404-350-8873
Practice Address - Street 1:3193 HOWELL MILL RD NW
Practice Address - Street 2:SUITE 223
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-2119
Practice Address - Country:US
Practice Address - Phone:404-351-5262
Practice Address - Fax:404-350-8873
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2014-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025076207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA110202103OtherRR MCAR
GA227194900OtherWORKERS COMP
GA00265933BMedicaid
GA$$$$$$$$$AMedicare PIN
GA00265933BMedicaid
GA227194900OtherWORKERS COMP