Provider Demographics
NPI:1962497081
Name:YOUNG, DOUGLAS B (PA)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:B
Last Name:YOUNG
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 HATCHER LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-3563
Mailing Address - Country:US
Mailing Address - Phone:615-828-3760
Mailing Address - Fax:
Practice Address - Street 1:1400 HATCHER LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-3563
Practice Address - Country:US
Practice Address - Phone:615-828-3760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA0000000919363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3679876Medicare ID - Type Unspecified
TNP63488Medicare UPIN
TN36798771Medicare PIN