Provider Demographics
NPI:1053331066
Name:DAVIS, S SCOTT JR (MD)
Entity Type:Individual
Prefix:
First Name:S
Middle Name:SCOTT
Last Name:DAVIS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 PEACHTREE ST NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2247
Mailing Address - Country:US
Mailing Address - Phone:404-686-8411
Mailing Address - Fax:
Practice Address - Street 1:550 PEACHTREE ST NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2247
Practice Address - Country:US
Practice Address - Phone:404-686-8411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056699208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA438683444CMedicaid
GA2439375OtherUNITED HEALTHCARE
GA931534OtherBCBS
GAP00291073OtherRAILROAD MEDICARE
GAY 20051001OtherPHCS
GA1084001OtherUS HEALTHCARE
GA1084001OtherUS HEALTHCARE
GA02BDHXWMedicare ID - Type Unspecified