Provider Demographics
NPI:1033243522
Name:SCOTT, CHARLES EDWIN JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:EDWIN
Last Name:SCOTT
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 E LEE ST
Mailing Address - Street 2:
Mailing Address - City:DAWSON
Mailing Address - State:GA
Mailing Address - Zip Code:39842-1557
Mailing Address - Country:US
Mailing Address - Phone:229-995-3553
Mailing Address - Fax:
Practice Address - Street 1:101 E LEE ST
Practice Address - Street 2:P O B 430
Practice Address - City:DAWSON
Practice Address - State:GA
Practice Address - Zip Code:39842-1485
Practice Address - Country:US
Practice Address - Phone:229-995-2131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH012037183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist