MEDICARE: TIM SCOTT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency
2	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1538002654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIM SCOTT

Provider Business Mailing Address
First Line	:	13000 S TRYON ST # F-279
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28278-7652
Country	:	US
Telephone Number	:	980-766-0233
Fax Number	:

Provider Business Practice Location Address
First Line	:	1936 WILDLIFE RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28214-8457
Country	:	US
Telephone Number	:	980-766-0233
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2026
Last Update Date	:	04/14/2026

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Directions to “ TIM SCOTT ” Practice Location

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