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General NPI Number Information
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NPI Number | 1609874197
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Entity Type | Individual
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Provider Name | ROBERT SCANLON DO
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Gender | Male
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Dates
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Enumeration Date | 07/08/2005
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Last Update Date | 06/20/2025
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Provider Practice Location Address
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Address Line | 1811 EDWINA DR
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City | VIDALIA
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State | GA
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Zip | 30474-8963
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Country | US
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Telephone | 912-538-8105
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Fax | 912-538-8109
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Provider Business Mailing Address
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Address Line | PO BOX 407
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City | VIDALIA
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State | GA
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Zip | 30475-0407
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Country | US
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Telephone | 912-537-4986
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Fax | 912-538-8109
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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 | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 65886
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 65886
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License Number State | GA
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