Provider Demographics
NPI:1205489929
Name:KONG, PHILIP YOUNG (FNP-C)
Entity type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:YOUNG
Last Name:KONG
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19084
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4085
Mailing Address - Country:US
Mailing Address - Phone:706-353-1516
Mailing Address - Fax:706-788-2936
Practice Address - Street 1:247 UNION POINT ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:GA
Practice Address - Zip Code:30648-2303
Practice Address - Country:US
Practice Address - Phone:706-743-8171
Practice Address - Fax:706-743-3000
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-22
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN237419363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily