Healthcare Provider Details

I. General information

NPI: 1407828338
Provider Name (Legal Business Name): SCOTT ASHLEY FOUCH PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2006
Last Update Date: 12/21/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1176 BRAMPTON AVE
STATESBORO GA
30458-0847
US

IV. Provider business mailing address

575 1ST ST
MACON GA
31201-2825
US

V. Phone/Fax

Practice location:
  • Phone: 912-259-9474
  • Fax: 122-255-7199
Mailing address:
  • Phone: 478-743-9762
  • Fax: 478-746-6612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3334
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: