Provider Demographics
NPI:1033449186
Name:SCURTI, CONNIE HARRIS (DO)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:HARRIS
Last Name:SCURTI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:CONNIE
Other - Middle Name:SHAYE
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:965 RIDGE LAKE BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-9446
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:255 BAPTIST BLVD STE 301
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-2006
Practice Address - Country:US
Practice Address - Phone:662-244-1705
Practice Address - Fax:662-227-4301
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS26779207R00000X
WV2478207R00000X
OH34.010472207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine