Provider Demographics
NPI:1194968776
Name:YOUNGBLOOD, LAURA BOND (MD)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:BOND
Last Name:YOUNGBLOOD
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:960 E. THIRD STREET, SUITE #208
Mailing Address - Street 2:CHCHA DBA UNIVERSITY MEDICAL ASSOCIATES
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403
Mailing Address - Country:US
Mailing Address - Phone:423-778-2550
Mailing Address - Fax:423-778-4452
Practice Address - Street 1:960 E. THIRD STREET, SUITE #208
Practice Address - Street 2:CHCHA DBA UNIVERSITY MEDICAL ASSOCIATES
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403
Practice Address - Country:US
Practice Address - Phone:423-778-2550
Practice Address - Fax:423-778-4452
Is Sole Proprietor?:No
Enumeration Date:2009-04-13
Last Update Date:2013-06-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN47855208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I116765Medicare PIN