Provider Demographics
NPI:1932693280
Name:YOUNG, EVERETT GLENN (MD)
Entity type:Individual
Prefix:
First Name:EVERETT
Middle Name:GLENN
Last Name:YOUNG
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 1:1272 VIRGIL LANGFORD RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606
Mailing Address - Country:US
Mailing Address - Phone:770-758-7903
Mailing Address - Fax:
Practice Address - Street 1:1272 VIRGIL LANGFORD RD
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-7245
Practice Address - Country:US
Practice Address - Phone:770-292-6500
Practice Address - Fax:770-292-6535
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-20
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLTRN27081207X00000X
PAMD481748207X00000X
GA99894207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery