Provider Demographics
NPI:1801346481
Name:YOUNG, GEORGE EUGENE I
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:EUGENE
Last Name:YOUNG
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:854 21ST ST NE
Mailing Address - Street 2:APT 7
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-4133
Mailing Address - Country:US
Mailing Address - Phone:619-763-6128
Mailing Address - Fax:
Practice Address - Street 1:854 21ST ST NE
Practice Address - Street 2:APT 7
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-4133
Practice Address - Country:US
Practice Address - Phone:619-763-6128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA7500374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide