=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174716146
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SCOTT T EMELY OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2007
-----------------------------------------------------
Last Update Date | 03/18/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4330 JOHNS CREEK PKWY SUITE 300
-----------------------------------------------------
City | SUWANEE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30024-6047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-232-7844
-----------------------------------------------------
Fax | 770-232-9455
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4330 JOHNS CREEK PKWY SUITE 300
-----------------------------------------------------
City | SUWANEE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30024-6047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-232-7844
-----------------------------------------------------
Fax | 770-232-9455
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 2336
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------