Provider Demographics
NPI:1700476348
Name:YOUNG, OOUIDA (RN)
Entity Type:Individual
Prefix:
First Name:OOUIDA
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 1:3722 STONEBRANCH LN
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-6326
Mailing Address - Country:US
Mailing Address - Phone:314-630-5310
Mailing Address - Fax:
Practice Address - Street 1:3722 STONEBRANCH LN
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-6326
Practice Address - Country:US
Practice Address - Phone:314-630-5310
Practice Address - Fax:888-398-3036
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory