Healthcare Provider Details

I. General information

NPI: 1841681293
Provider Name (Legal Business Name): COLE T SCOTTI PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2015
Last Update Date: 01/10/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 TOWNPARK LN NW KAISER PERMANENTE TOWNPARK COMPREHENSIVE MEDICAL CENTER
KENNESAW GA
30144-5579
US

IV. Provider business mailing address

3495 PIEDMONT RD NE NINE PIEDMONT CENTER
ATLANTA GA
30305-1717
US

V. Phone/Fax

Practice location:
  • Phone: 770-931-6012
  • Fax:
Mailing address:
  • Phone: 404-504-5678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number7501
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: