Provider Demographics
NPI:1588743165
Name:YOUNG-WILSON, CRYSTAL (DO)
Entity type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:
Last Name:YOUNG-WILSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2727 PACES FERRY RD SE STE 1-1100
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-6151
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1800 HOWELL MILL RD NW STE 650
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-3188
Practice Address - Country:US
Practice Address - Phone:404-537-8081
Practice Address - Fax:404-355-2360
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049824207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH66842Medicare UPIN