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General NPI Number Information
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NPI Number | 1386056422
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Entity Type | Individual
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Provider Name | SCOTT MIKELL
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Gender | Male
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Dates
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Enumeration Date | 05/23/2014
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Last Update Date | 01/11/2023
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Provider Practice Location Address
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Address Line | 658 NORTHSIDE DR E STE A
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City | STATESBORO
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State | GA
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Zip | 30458-4828
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Country | US
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Telephone | 912-764-9684
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 689022
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City | FRANKLIN
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State | TN
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Zip | 37068-9022
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Country | US
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Telephone | 615-465-7211
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Fax | 912-489-3676
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2017-01778
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 1031577657
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License Number State | GA
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