Provider Demographics
NPI:1841233855
Name:YOUNG, TAMADIS
Entity Type:Individual
Prefix:
First Name:TAMADIS
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 PEACHTREE ST NW
Mailing Address - Street 2:SUITE 426
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-2449
Mailing Address - Country:US
Mailing Address - Phone:800-761-0809
Mailing Address - Fax:404-541-9696
Practice Address - Street 1:1720 PEACHTREE ST NW
Practice Address - Street 2:SUITE 426
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-2449
Practice Address - Country:US
Practice Address - Phone:800-761-0809
Practice Address - Fax:404-541-9696
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA5270700001171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor