Provider Demographics
NPI:1154498004
Name:SCOTT, LEE ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:ANN
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2511 WESTOVER DRIVE
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458
Mailing Address - Country:US
Mailing Address - Phone:912-682-9650
Mailing Address - Fax:
Practice Address - Street 1:110 RUSHING LANE
Practice Address - Street 2:PO BOX 1681
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30459
Practice Address - Country:US
Practice Address - Phone:912-225-6447
Practice Address - Fax:800-470-4397
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002411103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10046939OtherAMERIGROUP MEDICAID
GA00859042AMedicaid
GAS86522Medicare UPIN
GA10046939OtherAMERIGROUP MEDICAID