Provider Demographics
NPI:1487151213
Name:YOUNG, JABBAR
Entity type:Individual
Prefix:
First Name:JABBAR
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3351 GROVE CRABTREE CRES APT 832
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-3074
Mailing Address - Country:US
Mailing Address - Phone:719-505-5719
Mailing Address - Fax:
Practice Address - Street 1:3351 GROVE CRABTREE CRES APT 832
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-3074
Practice Address - Country:US
Practice Address - Phone:719-505-5719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)