Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 035799 | GA |
NPI | 1033196183 |
---|---|
Provider Name | Dr. Scott Wells Ainsworth |
First Address | Blairsville, GA 30514-0759 |
Second Address | Blairsville, GA 30512-3139 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2005 |
Last Update Date | 07/05/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
005857 | BLUE CROSS BLUE SHIELD (01) | GA |
122605 | UNITED HEALTHCARE (01) | GA |
376554453A | (05) | GA |
890633G | (05) | NC |
F32424 | (02) | GA |