Provider Demographics
NPI:1760406813
Name:YOUNG, ANNE S (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:S
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 JACKSON TRACE RD
Mailing Address - Street 2:
Mailing Address - City:WETUMPKA
Mailing Address - State:AL
Mailing Address - Zip Code:36092-1504
Mailing Address - Country:US
Mailing Address - Phone:334-567-2882
Mailing Address - Fax:334-567-3361
Practice Address - Street 1:815 JACKSON TRACE RD
Practice Address - Street 2:
Practice Address - City:WETUMPKA
Practice Address - State:AL
Practice Address - Zip Code:36092-1504
Practice Address - Country:US
Practice Address - Phone:334-567-2882
Practice Address - Fax:334-567-3361
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0543434008Medicaid
AL0543434008Medicaid