Provider Demographics
NPI:1427092659
Name:YOUNG, JAMIE (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MD, PHD
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 265
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD COLLEGE
Mailing Address - State:NC
Mailing Address - Zip Code:28671-0265
Mailing Address - Country:US
Mailing Address - Phone:828-879-4567
Mailing Address - Fax:828-879-4560
Practice Address - Street 1:560 MALCOLM BLVD.
Practice Address - Street 2:
Practice Address - City:RUTHERFORD COLLEGE
Practice Address - State:NC
Practice Address - Zip Code:28671
Practice Address - Country:US
Practice Address - Phone:828-879-4567
Practice Address - Fax:828-879-4560
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-00149207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCBY7437254OtherDEA
NCBY7437254OtherDEA
NC2051776CMedicare PIN