Healthcare Provider Details

I. General information

NPI: 1629309554
Provider Name (Legal Business Name): CAMILLE K SCOTT D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2010
Last Update Date: 01/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 HAMMOND DR NE SUITE D 4285
ATLANTA GA
30328-5320
US

IV. Provider business mailing address

175 PRESTON OAKS DR
ALPHARETTA GA
30022-7689
US

V. Phone/Fax

Practice location:
  • Phone: 770-552-0857
  • Fax: 770-522-9878
Mailing address:
  • Phone: 770-777-4787
  • Fax: 770-777-4787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCHIR008542
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: