MEDICARE: DR. CRYSTAL M SCOTT MSW

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1578342713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRYSTAL M SCOTT MSW

Provider Business Mailing Address
First Line	:	7827 BLUEFIN TRL
Second Line	:
City	:	UNION CITY
State	:	GA
Zip	:	30291-3463
Country	:	US
Telephone Number	:	678-949-8669
Fax Number	:

Provider Business Practice Location Address
First Line	:	7827 BLUEFIN TRL
Second Line	:
City	:	UNION CITY
State	:	GA
Zip	:	30291-3463
Country	:	US
Telephone Number	:	678-949-8669
Fax Number	:

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

Provider Enumeration Date	:	09/27/2023
Last Update Date	:	09/27/2023

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