Provider Demographics
NPI:1740627991
Name:YOUNG, KISHA JANELLE (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:KISHA
Middle Name:JANELLE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:MRS
Other - First Name:KISHA
Other - Middle Name:JANELLE
Other - Last Name:YOUNG-COLLIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4460 AUSTELL RD
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1844
Mailing Address - Country:US
Mailing Address - Phone:770-944-3616
Mailing Address - Fax:770-941-3047
Practice Address - Street 1:4460 AUSTELL RD
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1844
Practice Address - Country:US
Practice Address - Phone:770-944-3616
Practice Address - Fax:770-941-3047
Is Sole Proprietor?:No
Enumeration Date:2013-05-29
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN549982084N0400X
GA907132084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology