Healthcare Provider Details

I. General information

NPI: 1942296181
Provider Name (Legal Business Name): WILLIAM M SCOTT III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 WALL ST
PIEDMONT SC
29673-6754
US

IV. Provider business mailing address

206 WALL ST
PIEDMONT SC
29673-6754
US

V. Phone/Fax

Practice location:
  • Phone: 864-269-7950
  • Fax: 864-269-7948
Mailing address:
  • Phone: 864-269-7950
  • Fax: 864-269-7948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number8878
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: