Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | CHIR007708 | GA |
NPI | 1356352389 |
---|---|
Provider Name | Dr. Scott Howard De Pol |
First Address | Alpharetta, GA 30004-1185 |
Second Address | Chattanooga, TN 37421-1971 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2006 |
Last Update Date | 29/08/2007 |