MEDICARE: MRS. KARMEN RENEE SCOTT L.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	133NN1002X	Nutrition Education Nutritionist	LD001806	GA

General Provider Information

NPI Number	:	1720072135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KARMEN RENEE SCOTT L.D.

Provider Business Mailing Address
First Line	:	135 HENRY PKWY
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-6636
Country	:	US
Telephone Number	:	770-954-2250
Fax Number	:	770-954-2854

Provider Business Practice Location Address
First Line	:	135 HENRY PKWY
Second Line	:
City	:	MCDONOUGH
State	:	GA
Zip	:	30253-6636
Country	:	US
Telephone Number	:	770-954-2250
Fax Number	:	770-954-2854

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

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	07/08/2007

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