MEDICARE: PIEDMONT MEDICAL ASSOCIATES, LLC

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	261QP2300X	Primary Care Clinic/Center		GA

General Provider Information

NPI Number	:	1588024251
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIEDMONT MEDICAL ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 53155
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30355-1155
Country	:	US
Telephone Number	:	404-231-4231
Fax Number	:

Provider Business Practice Location Address
First Line	:	4062 PEACHTREE RD NE
Second Line	:	STE C
City	:	BROOKHAVEN
State	:	GA
Zip	:	30319-3021
Country	:	US
Telephone Number	:	404-231-4231
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN MANAGING MEMBER
Name	:	DAVID SCURLOCK
Credential	:	M.D.
Telephone Number	:	404-966-0385

Provider Enumeration Date	:	02/24/2016
Last Update Date	:	02/24/2016

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