Provider Demographics
NPI:1124183371
Name:WERNER, SCOT M (OD)
Entity Type:Individual
Prefix:
First Name:SCOT
Middle Name:M
Last Name:WERNER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 PEEKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:GA
Mailing Address - Zip Code:30248-3125
Mailing Address - Country:US
Mailing Address - Phone:770-230-0700
Mailing Address - Fax:770-230-0707
Practice Address - Street 1:24 PEEKSVILLE RD
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248-3125
Practice Address - Country:US
Practice Address - Phone:770-230-0700
Practice Address - Fax:770-230-0707
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1919152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000909356CMedicaid
GA000909356CMedicaid