MEDICARE: SCOTT CHARLES EVERETT

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	390200000X	Student in an Organized Health Care Education/Training Program		NC

General Provider Information

NPI Number	:	1972363703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT CHARLES EVERETT

Provider Business Mailing Address
First Line	:	1 MEDICAL CENTER BOULEVARD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27157-0001
Country	:	US
Telephone Number	:	336-716-4625
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 MEDICAL CENTER BOULEVARD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27157-4062
Country	:	US
Telephone Number	:	336-716-4625
Fax Number	:

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

Provider Enumeration Date	:	03/20/2024
Last Update Date	:	03/25/2024

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Directions to “ SCOTT CHARLES EVERETT ” Practice Location

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