Healthcare Provider Details

I. General information

NPI: 1083714612
Provider Name (Legal Business Name): JONETTE SCOTT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 08/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15024 MARTIN LUTHER KING JR BLVD
GULFPORT MS
39501-8306
US

IV. Provider business mailing address

PO BOX 475
BILOXI MS
39533-0475
US

V. Phone/Fax

Practice location:
  • Phone: 228-864-0003
  • Fax: 228-863-7917
Mailing address:
  • Phone: 228-374-2494
  • Fax: 228-374-0856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number12293
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: