Provider Demographics
NPI:1932166329
Name:YOUNG, STEWART GREGORY (MD)
Entity Type:Individual
Prefix:
First Name:STEWART
Middle Name:GREGORY
Last Name:YOUNG
Suffix:
Gender:M
Credentials:MD
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 402145
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-2145
Mailing Address - Country:US
Mailing Address - Phone:803-296-7305
Mailing Address - Fax:803-296-7330
Practice Address - Street 1:2406 DECKER BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29206-2362
Practice Address - Country:US
Practice Address - Phone:803-736-2530
Practice Address - Fax:803-736-4830
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12878207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC128784Medicaid
SCP00841371OtherMEDICARE RAILROAD
SCD17640Medicare UPIN
SCP00841371OtherMEDICARE RAILROAD
SC128784Medicaid