Healthcare Provider Details

I. General information

NPI: 1508143892
Provider Name (Legal Business Name): SHEREE LAVETTE SCOTT PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2011
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 LOWER FAYETTEVILLE RD STE 2000
NEWNAN GA
30265-6506
US

IV. Provider business mailing address

1111 LOWER FAYETTEVILLE RD STE 2000
NEWNAN GA
30265-6506
US

V. Phone/Fax

Practice location:
  • Phone: 770-251-7284
  • Fax:
Mailing address:
  • Phone: 770-251-7284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA22148
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA40455
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: