Healthcare Provider Details

I. General information

NPI: 1801054739
Provider Name (Legal Business Name): SCOTT SNYDER, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2008
Last Update Date: 06/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1999 PRINCE AVE
ATHENS GA
30606-6013
US

IV. Provider business mailing address

1999 PRINCE AVE
ATHENS GA
30606-6013
US

V. Phone/Fax

Practice location:
  • Phone: 706-543-0059
  • Fax: 706-543-0290
Mailing address:
  • Phone: 706-543-0059
  • Fax: 706-543-0290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number27918
License Number StateGA

VIII. Authorized Official

Name: DR. SCOTT SNYDER
Title or Position: MEDICAL DOCTOR
Credential:
Phone: 706-543-0059