Provider Demographics
NPI:1821791252
Name:YOUNG, MARLIE THOMAS (CRNA)
Entity type:Individual
Prefix:
First Name:MARLIE
Middle Name:THOMAS
Last Name:YOUNG
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:MARLIE
Other - Middle Name:KYNDALL
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:654 US HIGHWAY 319 S
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-1447
Mailing Address - Country:US
Mailing Address - Phone:229-921-6275
Mailing Address - Fax:
Practice Address - Street 1:330 N BROAD ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-8106
Practice Address - Country:US
Practice Address - Phone:229-228-7034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-24
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN249788367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered