MEDICARE: DARRELL KEVIN SCALES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	054937	GA
2	207X00000X	Orthopaedic Surgery Physician	054937	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235187030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARRELL KEVIN SCALES MD

Provider Business Mailing Address
First Line	:	PO BOX 742616
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-2616
Country	:	US
Telephone Number	:	770-219-8420
Fax Number	:

Provider Business Practice Location Address
First Line	:	1404 RIVER PL STE 401
Second Line	:
City	:	BRASELTON
State	:	GA
Zip	:	30517-5600
Country	:	US
Telephone Number	:	770-848-6190
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	10/15/2020

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Directions to “ DARRELL KEVIN SCALES MD” Practice Location

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