Healthcare Provider Details

I. General information

NPI: 1376875450
Provider Name (Legal Business Name): JULIE SCOTT W.H.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2010
Last Update Date: 02/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6770 SELMAN DR
DOUGLASVILLE GA
30134-1756
US

IV. Provider business mailing address

1664 BRADMERE LN
LITHIA SPRINGS GA
30122-3251
US

V. Phone/Fax

Practice location:
  • Phone: 770-949-1970
  • Fax:
Mailing address:
  • Phone: 678-945-6163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number161501
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: