Provider Demographics
NPI:1053331017
Name:MCPHERSON, SCOTT T (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:T
Last Name:MCPHERSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PRIME PT
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-6851
Mailing Address - Country:US
Mailing Address - Phone:770-487-5505
Mailing Address - Fax:770-487-5266
Practice Address - Street 1:300 PRIME PT
Practice Address - Street 2:SUITE 202
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-6851
Practice Address - Country:US
Practice Address - Phone:770-487-5505
Practice Address - Fax:770-487-5266
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA111021223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics