Provider Demographics
NPI:1295119832
Name:YOUNG, TASHA (RN)
Entity type:Individual
Prefix:
First Name:TASHA
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 W PEACHTREE ST. NW 200
Mailing Address - Street 2:UNITE 25349
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3838
Mailing Address - Country:US
Mailing Address - Phone:678-909-9035
Mailing Address - Fax:
Practice Address - Street 1:2512 OAKWOOD WAY SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-3838
Practice Address - Country:US
Practice Address - Phone:678-909-9035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN186121163WC1500X, 171M00000X, 163WG0000X
171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No171400000XOther Service ProvidersHealth & Wellness Coach
No171M00000XOther Service ProvidersCase Manager/Care Coordinator