Healthcare Provider Details

I. General information

NPI: 1275578239
Provider Name (Legal Business Name): CARL ALAN SCOTT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4451 COUNTRY CLUB RD STE 3A
STATESBORO GA
30458-9238
US

IV. Provider business mailing address

PO BOX 689022
FRANKLIN TN
37068-9022
US

V. Phone/Fax

Practice location:
  • Phone: 912-764-2273
  • Fax: 912-489-4762
Mailing address:
  • Phone: 615-465-7211
  • Fax: 615-628-6877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number054052
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: