Provider Demographics
NPI:1013911668
Name:YOUNG, TAMMY H (MD)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:H
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1227 N STATE ST
Mailing Address - Street 2:STE 101
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-2002
Mailing Address - Country:US
Mailing Address - Phone:601-355-2485
Mailing Address - Fax:601-353-1463
Practice Address - Street 1:1227 N STATE ST
Practice Address - Street 2:STE 101
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2002
Practice Address - Country:US
Practice Address - Phone:601-355-2485
Practice Address - Fax:601-353-1463
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2022-12-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MS14971207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS000125697Medicaid
7435369OtherAETNA HEALTHCARE
H62261Medicare UPIN
MS830000053Medicare PIN