Provider Demographics
NPI:1639150766
Name:YOUNG, JAMES ROGERS II (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ROGERS
Last Name:YOUNG
Suffix:II
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 1:3 SAINT FRANCIS DR
Mailing Address - Street 2:SUITE 360
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-3971
Mailing Address - Country:US
Mailing Address - Phone:864-233-4349
Mailing Address - Fax:
Practice Address - Street 1:3 SAINT FRANCIS DR
Practice Address - Street 2:SUITE 360
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3971
Practice Address - Country:US
Practice Address - Phone:864-233-4349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14197208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1295769438OtherGROUP NPI
SC8157OtherMEDICARE PTAN
SCA724378157Medicare PIN
SC8157OtherMEDICARE PTAN