Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | 000038 | GA |
N | 225100000X | Physical Therapist | PT003946 | GA |
NPI | 1477875201 |
---|---|
Provider Name | Carolyn Denise Scott |
First Address | Smyrna, GA 30080-7351 |
Second Address | Atlanta, GA 30312-1110 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2010 |
Last Update Date | 21/02/2010 |