MEDICARE: MR. ANTHONY LEON PRESCOTT

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	390200000X	Student in an Organized Health Care Education/Training Program		GA

General Provider Information

NPI Number	:	1588278998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANTHONY LEON PRESCOTT

Provider Business Mailing Address
First Line	:	3025 BULL ST
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31405-2016
Country	:	US
Telephone Number	:	912-663-6979
Fax Number	:

Provider Business Practice Location Address
First Line	:	14045 ABERCORN ST
Second Line	:
City	:	SAVANNAH
State	:	GA
Zip	:	31419-1957
Country	:	US
Telephone Number	:	912-663-6979
Fax Number	:

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

Provider Enumeration Date	:	09/02/2020
Last Update Date	:	09/02/2020

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