Healthcare Provider Details

I. General information

NPI: 1376459099
Provider Name (Legal Business Name): KIMBERLY LAVETTE SCOTT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 SHAWNEE ST
SAVANNAH GA
31419-1618
US

IV. Provider business mailing address

1170 SHAWNEE ST
SAVANNAH GA
31419-1618
US

V. Phone/Fax

Practice location:
  • Phone: 912-920-0214
  • Fax:
Mailing address:
  • Phone: 912-920-0214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN057776
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: