Provider Demographics
NPI:1801520564
Name:DEYOUNG, MARYN HAYWARD (PA-C, MPH)
Entity type:Individual
Prefix:
First Name:MARYN
Middle Name:HAYWARD
Last Name:DEYOUNG
Suffix:
Gender:
Credentials:PA-C, MPH
Other - Prefix:
Other - First Name:MARYN
Other - Middle Name:BURNS
Other - Last Name:HAYWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C, MPH
Mailing Address - Street 1:5582 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-3215
Mailing Address - Country:US
Mailing Address - Phone:404-492-7346
Mailing Address - Fax:404-297-7595
Practice Address - Street 1:5582 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-3215
Practice Address - Country:US
Practice Address - Phone:044-927-3464
Practice Address - Fax:404-297-7595
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-10
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11451363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant