Healthcare Provider Details

I. General information

NPI: 1952502346
Provider Name (Legal Business Name): SOUTHERN CRESCENT PSYCHIATRY AND COUSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 JUSLYN DR
HARVEST AL
35749-9513
US

IV. Provider business mailing address

115 JUSLYN DR
HARVEST AL
35749-9513
US

V. Phone/Fax

Practice location:
  • Phone: 256-851-9507
  • Fax: 256-851-9507
Mailing address:
  • Phone: 256-851-9507
  • Fax: 256-851-9507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number033447
License Number StateGA

VIII. Authorized Official

Name: DR. DONNA JEAN SCOTT
Title or Position: OWNER
Credential: MD
Phone: 256-851-9507