Healthcare Provider Details

I. General information

NPI: 1205881489
Provider Name (Legal Business Name): HEATH ELLIOTT SCOTT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 E FIFTEENTH ST
YAZOO CITY MS
39194-7607
US

IV. Provider business mailing address

PO BOX 1509
YAZOO CITY MS
39194-1509
US

V. Phone/Fax

Practice location:
  • Phone: 662-746-6083
  • Fax: 662-746-1954
Mailing address:
  • Phone: 662-746-6083
  • Fax: 662-746-1954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18042
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: