Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 057322 | GA |
N | 207P00000X | Emergency Physician | D34537 | MD |
NPI | 1003858242 |
---|---|
Provider Name | Carol Scott |
First Address | Baltimore, MD 21209-1014 |
Second Address | Milledgeville, GA 31061-2343 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 06/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
482371100 | (05) | MD |
60609101 | BLUE CROSS (01) | MD |
OTH000 | (02) | MD |
P00287588 | RAILROAD MEDICARE (01) | MD |