MEDICARE: J SCOTT BRICKMAN M.D.

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	174400000X	Specialist	45042	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	:	1306849831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	J SCOTT BRICKMAN M.D.

Provider Business Mailing Address
First Line	:	4279 FOREST LAKE DR W
Second Line	:
City	:	TIFTON
State	:	GA
Zip	:	31794-2352
Country	:	US
Telephone Number	:	229-848-6058
Fax Number	:

Provider Business Practice Location Address
First Line	:	4279 FOREST LAKE DR W
Second Line	:
City	:	TIFTON
State	:	GA
Zip	:	31794-2352
Country	:	US
Telephone Number	:	229-848-6058
Fax Number	:

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

Provider Enumeration Date	:	05/30/2005
Last Update Date	:	03/25/2008

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