Provider Demographics
NPI:1467676676
Name:YOUNGBLOOD, JESS H (MD)
Entity type:Individual
Prefix:
First Name:JESS
Middle Name:H
Last Name:YOUNGBLOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2017 OBRIG AVE
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-2156
Mailing Address - Country:US
Mailing Address - Phone:256-582-2324
Mailing Address - Fax:256-582-2321
Practice Address - Street 1:2017 OBRIG AVE
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-2156
Practice Address - Country:US
Practice Address - Phone:256-582-2324
Practice Address - Fax:256-582-2321
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL27882208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice