Healthcare Provider Details

I. General information

NPI: 1548258353
Provider Name (Legal Business Name): DAVID G. SCOTT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1285 HEMBREE RD SUITE 200-A
ROSWELL GA
30076-5720
US

IV. Provider business mailing address

1285 HEMBREE RD SUITE 200-A
ROSWELL GA
30076-5720
US

V. Phone/Fax

Practice location:
  • Phone: 770-475-2710
  • Fax: 770-360-0498
Mailing address:
  • Phone: 770-475-2710
  • Fax: 770-360-0498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number038950
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number038950
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: