Provider Demographics
NPI:1942234604
Name:JOE, YOUNG CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:YOUNG
Middle Name:CHARLES
Last Name:JOE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7182 WHITES CREEK PIKE
Mailing Address - Street 2:PO BOX 70
Mailing Address - City:JOELTON
Mailing Address - State:TN
Mailing Address - Zip Code:37080
Mailing Address - Country:US
Mailing Address - Phone:615-876-0083
Mailing Address - Fax:615-876-8860
Practice Address - Street 1:7182 WHITES CREEK PIKE
Practice Address - Street 2:
Practice Address - City:JOELTON
Practice Address - State:TN
Practice Address - Zip Code:37080
Practice Address - Country:US
Practice Address - Phone:615-876-0083
Practice Address - Fax:615-876-8860
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD9230207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2008439Medicaid
TNBO2815Medicare UPIN
TN2008439Medicaid