Walter Fuller Young, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

007392 Issued in GA

Practice address

2265 Cascade Rd SW
Atlanta, GA 30311-2801

Phone

(404) 753-4753

Fax

(404) 753-4228

NPI assigned

Jun 7, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• S23 of Georgia, LLC

  • Dentist
  • Atlanta, GA
  • NPI 1578415113
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1224806400000",
    "number": "1003019050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2265 CASCADE RD SW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303112801",
            "telephone_number": "404-753-4753",
            "fax_number": "404-753-4228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2265 CASCADE RD SW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303112801",
            "telephone_number": "404-753-4753",
            "fax_number": "404-753-4228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOUNG",
        "first_name": "WALTER",
        "middle_name": "FULLER",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-07",
        "last_updated": "2008-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "007392",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00057153A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tamadis Young
• Tatyana Young
• Tempest Young
• Timothy Ames Young, MD
• Trudye A Young, MD
• Heather Voelkel Youngblood, MSW, LCSW
• Laura Lucas Youngblood, CPNP
• Meaghan Youngblood, MS, RDN, LD
• Amy K Youngman, RPH
• Maya Younker

• Dentist in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.