Healthcare Provider Details

I. General information

NPI: 1780188276
Provider Name (Legal Business Name): STEPHEN ROBERT SCOTT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 HICKORY FLAT HWY STE 200
CANTON GA
30115-3500
US

IV. Provider business mailing address

1521 HICKORY FLAT HWY STE 200
CANTON GA
30115-3500
US

V. Phone/Fax

Practice location:
  • Phone: 470-297-1310
  • Fax:
Mailing address:
  • Phone: 470-297-1310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number90997
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number90997
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: