Provider Demographics
NPI:1295762037
Name:YOUNG, GEORGINA (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGINA
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GEORGINA
Other - Middle Name:
Other - Last Name:FERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:519 HEDGECROFT DR
Mailing Address - Street 2:
Mailing Address - City:SEABROOK
Mailing Address - State:TX
Mailing Address - Zip Code:77586-5831
Mailing Address - Country:US
Mailing Address - Phone:281-554-0177
Mailing Address - Fax:281-554-0178
Practice Address - Street 1:2401 FM 646 RD W
Practice Address - Street 2:SUITE C
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-3249
Practice Address - Country:US
Practice Address - Phone:281-554-0177
Practice Address - Fax:281-554-0178
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL67282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5874713120OtherCHAMPUS
TX165076401Medicaid
TX5874713120OtherCHAMPUS
TX165076401Medicaid