Healthcare Provider Details

I. General information

NPI: 1871613240
Provider Name (Legal Business Name): SOUTHERN CRESCENT PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4218 US HIGHWAY 31 S
DECATUR AL
35603-5039
US

IV. Provider business mailing address

PO BOX 91328
LOUISVILLE KY
40291-0328
US

V. Phone/Fax

Practice location:
  • Phone: 770-480-6222
  • Fax: 866-501-4299
Mailing address:
  • Phone: 770-480-6222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0027175
License Number StateAL

VIII. Authorized Official

Name: DR. DONNA JEAN SCOTT
Title or Position: OWNER
Credential: M.D.
Phone: 770-480-6222