Provider Demographics
NPI:1669605739
Name:YOUNG, BETH BURCH (NP-C)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:BURCH
Last Name:YOUNG
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2754 OLD KINGS BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NICHOLSON
Mailing Address - State:GA
Mailing Address - Zip Code:30565-2917
Mailing Address - Country:US
Mailing Address - Phone:770-856-2048
Mailing Address - Fax:
Practice Address - Street 1:2470 DANIELS BRIDGE RD
Practice Address - Street 2:BLDG 200, SUITE 251
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6187
Practice Address - Country:US
Practice Address - Phone:706-389-3440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-24
Last Update Date:2014-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN047409363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health