Healthcare Provider Details

I. General information

NPI: 1629076393
Provider Name (Legal Business Name): RICHARD SCOTT MCGILL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4307 HIGHWAY 66 S
ROGERSVILLE TN
37857-3155
US

IV. Provider business mailing address

PO BOX 850
ROGERSVILLE TN
37857-0850
US

V. Phone/Fax

Practice location:
  • Phone: 423-921-1600
  • Fax: 423-921-1681
Mailing address:
  • Phone: 423-921-1600
  • Fax: 423-921-1681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0102204721
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDO0000001255
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: