Provider Demographics
NPI:1093063380
Name:YOUNG, JENNIFER ELLEN (MSM, PA-C)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ELLEN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MSM, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2227 PLANTATION DR
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-2118
Mailing Address - Country:US
Mailing Address - Phone:615-513-7804
Mailing Address - Fax:
Practice Address - Street 1:1800 HOWELL MILL RD NW STE 500
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-2594
Practice Address - Country:US
Practice Address - Phone:404-367-3350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-17
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07823363AM0700X
GA8327363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical