MEDICARE: BETTY SCOTT NOBLE PHD

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	103T00000X	Psychologist	001221	GA
2	103T00000X	Psychologist	649	SC
3	103T00000X	Psychologist	P0000001170	TN

General Provider Information

NPI Number	:	1750392031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETTY SCOTT NOBLE PHD

Provider Business Mailing Address
First Line	:	300 W WIEUCA RD NE
Second Line	:	BUILDING 2, SUITE 314
City	:	ATLANTA
State	:	GA
Zip	:	30342-3352
Country	:	US
Telephone Number	:	404-255-4206
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 W WIEUCA RD NE
Second Line	:	BUILDING 2, SUITE 314
City	:	ATLANTA
State	:	GA
Zip	:	30342-3352
Country	:	US
Telephone Number	:	404-255-4206
Fax Number	:

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

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	07/08/2007

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