=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912994344
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SCOTT M. LEVERE M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2005
-----------------------------------------------------
Last Update Date | 02/05/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2041 MESA VALLEY WAY SUITE 100
-----------------------------------------------------
City | AUSTELL
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30106-8157
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-944-1100
-----------------------------------------------------
Fax | 770-944-6469
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2041 MESA VALLEY WAY SUITE 100
-----------------------------------------------------
City | AUSTELL
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30106-8157
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-944-1100
-----------------------------------------------------
Fax | 770-944-6469
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 037017
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207XS0106X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Hand Surgery Physician
-----------------------------------------------------
License Number | 037017
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------