Provider Demographics
NPI:1245265677
Name:YOUNG, GEORGE MORRISON JR (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:MORRISON
Last Name:YOUNG
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GEORGE
Other - Middle Name:M
Other - Last Name:YOUNG
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:11761-8 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-6699
Mailing Address - Country:US
Mailing Address - Phone:904-642-3304
Mailing Address - Fax:904-642-8375
Practice Address - Street 1:11761-8 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-6699
Practice Address - Country:US
Practice Address - Phone:904-642-3304
Practice Address - Fax:904-642-8375
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57406207QA0505X, 207Q00000X, 208D00000X
GA030930207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009375000Medicaid
FL11906OMedicare PIN
FLD-42276Medicare UPIN
FL009375000Medicaid