Provider Demographics
NPI:1912238460
Name:YOUNG, BRADLEY HARPER (FNP-BC)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:HARPER
Last Name:YOUNG
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 RT STANLEY SR PL
Mailing Address - Street 2:
Mailing Address - City:LYONS
Mailing Address - State:GA
Mailing Address - Zip Code:30436-5623
Mailing Address - Country:US
Mailing Address - Phone:912-526-9355
Mailing Address - Fax:912-526-8622
Practice Address - Street 1:110 RT STANLEY SR PL
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:GA
Practice Address - Zip Code:30436-5623
Practice Address - Country:US
Practice Address - Phone:912-526-9355
Practice Address - Fax:912-526-8622
Is Sole Proprietor?:No
Enumeration Date:2010-01-22
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004636363LF0000X
GARN218687363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003116137AMedicaid
GARN218687OtherSTATE LICENSE