Provider Demographics
NPI:1144399080
Name:SCOTT, CHARLENE SPANN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLENE
Middle Name:SPANN
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 405633
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-4633
Mailing Address - Country:US
Mailing Address - Phone:336-584-5659
Mailing Address - Fax:336-584-4072
Practice Address - Street 1:1409 UNIVERSITY DR
Practice Address - Street 2:SUITE 105
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8776
Practice Address - Country:US
Practice Address - Phone:336-584-5659
Practice Address - Fax:336-584-4072
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9700393207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891018HMedicaid
NC891018HMedicaid
NCG50620Medicare UPIN