Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 054937 | GA |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 054937 | GA |
NPI | 1235187030 |
---|---|
Provider Name | Darrell Kevin Scales |
First Address | Atlanta, GA 30374-2616 |
Second Address | Braselton, GA 30517-5600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 15/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
885647467A | (05) | GA |
H72648 | (02) |