Jennifer Youngblood, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

72931 Issued in GA

Practice address

1510 Hudson Bridge Rd
Stockbridge, GA 30281-5020

Phone

(404) 785-8660

Fax

(404) 785-8730

NPI assigned

Jun 2, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1275436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654473600000",
    "number": "1487974481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1510 HUDSON BRIDGE RD",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302815020",
            "telephone_number": "404-785-8660",
            "fax_number": "404-785-8730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1510 HUDSON BRIDGE RD",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302815020",
            "telephone_number": "404-785-8660",
            "fax_number": "404-785-8730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOUNGBLOOD",
        "first_name": "JENNIFER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-02",
        "last_updated": "2022-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "72931",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "choa@choa.gadirect.net",
            "affiliation": "N",
            "address_1": "1510 Hudson Bridge Rd",
            "city": "Stockbridge",
            "state": "GA",
            "country_code": "US",
            "postal_code": "302815020",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Angelique Young, ARNP
• Anisha Young
• Jasmine Young, PT, DPT
• Antonesha Latrice Youngblood
• Elaine C Youngblood, MD
• Mary Beth Yu, PHARM. D.
• Zam Zam Medical Clinic LLC
• Daniel Zavadil
• Sharika Zellars, MA,LPC
• Oprah Zeon, LMFT

• Pediatrics Physician in Stockbridge, GA
• Providers in Stockbridge, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.