Basic Information
| Provider Information | |||||||||
| NPI: | 1124094065 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YOUNG | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1014 FORSYTH ST | ||||||||
| Address2: | |||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312012051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4786338100 | ||||||||
| FaxNumber: | 4786336268 | ||||||||
| Practice Location | |||||||||
| Address1: | 1014 FORSYTH ST | ||||||||
| Address2: | |||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312012051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4786338100 | ||||||||
| FaxNumber: | 4786336268 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2006 | ||||||||
| LastUpdateDate: | 08/18/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 048101 | GA | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080P0006X | 048101 | GA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Developmental – Behavioral Pediatrics |
No ID Information.