Provider Demographics
NPI:1154694735
Name:YOUNG-SMITH, DENISE DEBORAH (CNA)
Entity type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:DEBORAH
Last Name:YOUNG-SMITH
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 CHERRY BLOSSOM CIR SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-6715
Mailing Address - Country:US
Mailing Address - Phone:678-334-4972
Mailing Address - Fax:
Practice Address - Street 1:2701 CHERRY BLOSSOM CIR SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-6715
Practice Address - Country:US
Practice Address - Phone:678-334-4972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-13
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA71693374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide