Provider Demographics
NPI:1912297912
Name:YOUNG, G CHARLES
Entity Type:Individual
Prefix:MR
First Name:G
Middle Name:CHARLES
Last Name:YOUNG
Suffix:
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:PO BOX 22
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-0022
Mailing Address - Country:US
Mailing Address - Phone:803-254-7666
Mailing Address - Fax:803-254-2223
Practice Address - Street 1:1607 BERNARDIN AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2003
Practice Address - Country:US
Practice Address - Phone:803-254-7666
Practice Address - Fax:803-254-2223
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC164237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist