Provider Demographics
NPI:1073512125
Name:MILES, SCOTT THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:THOMAS
Last Name:MILES
Suffix:
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 1:5155 GA HWY 40 EAST
Mailing Address - Street 2:
Mailing Address - City:ST. MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558
Mailing Address - Country:US
Mailing Address - Phone:912-434-1794
Mailing Address - Fax:912-662-8785
Practice Address - Street 1:5155 GA HIGHWAY 40 EAST
Practice Address - Street 2:
Practice Address - City:ST. MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558
Practice Address - Country:US
Practice Address - Phone:912-434-1794
Practice Address - Fax:912-662-8785
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME125620207QA0401X
IN1034481A207QA0401X
IN01034481207VG0400X
GA074308207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IND16136Medicare UPIN
IN277210Medicare ID - Type Unspecified