Healthcare Provider Details

I. General information

NPI: 1528406261
Provider Name (Legal Business Name): SCOTT A VAN NEST CST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 06/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3180 N POINT PKWY BUILDING 200 STE 207
ALPHARETTA GA
30005-4248
US

IV. Provider business mailing address

3180 N POINT PKWY BUILDING 200 STE 207
ALPHARETTA GA
30005-4248
US

V. Phone/Fax

Practice location:
  • Phone: 770-559-8725
  • Fax: 770-559-8276
Mailing address:
  • Phone: 770-559-8725
  • Fax: 770-559-8276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number128298
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: