Provider Demographics
NPI:1669464137
Name:YOUNG, GEORGE CLIFTON SR (ATC)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:CLIFTON
Last Name:YOUNG
Suffix:SR
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3822 WATERFORD WAY
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-8812
Mailing Address - Country:US
Mailing Address - Phone:940-484-7261
Mailing Address - Fax:
Practice Address - Street 1:3000 N I-35
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-5119
Practice Address - Country:US
Practice Address - Phone:940-898-7166
Practice Address - Fax:940-898-7311
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT01172255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer