Provider Demographics
NPI:1629017819
Name:YOUNGER, ROBERT E III (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:YOUNGER
Suffix:III
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 1:7923 WOLFTEVER DR
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6258
Mailing Address - Country:US
Mailing Address - Phone:423-322-5968
Mailing Address - Fax:
Practice Address - Street 1:7923 WOLFTEVER DR
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-6258
Practice Address - Country:US
Practice Address - Phone:423-322-5968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031373207K00000X
TNMD012917207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I035273Medicare PIN
B58886Medicare UPIN
GA202I033441Medicare PIN