Provider Demographics
NPI:1639134976
Name:YOUNG, RONDALL ATLEE (MD)
Entity Type:Individual
Prefix:DR
First Name:RONDALL
Middle Name:ATLEE
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 GREEN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7025
Mailing Address - Country:US
Mailing Address - Phone:336-272-9447
Mailing Address - Fax:336-272-2112
Practice Address - Street 1:719 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7014
Practice Address - Country:US
Practice Address - Phone:336-272-9447
Practice Address - Fax:336-272-2112
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30976208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8989820Medicaid
NC8989820Medicaid