Basic Information
| Provider Information | |||||||||
| NPI: | 1528098993 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | YOUTHCARE,PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 OSIGIAN BLVD # B | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | WARNER ROBINS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310887880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4789535358 | ||||||||
| FaxNumber: | 4789535340 | ||||||||
| Practice Location | |||||||||
| Address1: | 233 N HOUSTON RD | ||||||||
| Address2: | SUITE 140-H | ||||||||
| City: | WARNER ROBINS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310933074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4789233360 | ||||||||
| FaxNumber: | 4789239977 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | WADE | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | STEPHEN | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 4789233360 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 031350 | GA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.