Provider Demographics
NPI:1164421780
Name:LEPOR, SCOTT E (DO)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:E
Last Name:LEPOR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12938
Mailing Address - Street 2:C/O CLINIC MANAGEMENT
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 TIMMS RD NE
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-2067
Practice Address - Country:US
Practice Address - Phone:706-625-0022
Practice Address - Fax:706-625-8586
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060922207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA115888018BMedicaid
IN000000231138OtherANTHEM BCBS #
GA115888018AMedicaid
IN200377550Medicaid
IN184640JMedicare PIN
GA202I083135Medicare PIN
IN000000231138OtherANTHEM BCBS #
GA115888018AMedicaid