Provider Demographics
NPI:1235213158
Name:SCOTT, JESSE B (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:B
Last Name:SCOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:601 S VETERANS BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENNVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30427-1775
Mailing Address - Country:US
Mailing Address - Phone:912-654-0475
Mailing Address - Fax:912-654-0486
Practice Address - Street 1:501 E LONG ST
Practice Address - Street 2:
Practice Address - City:CLAXTON
Practice Address - State:GA
Practice Address - Zip Code:30417-1435
Practice Address - Country:US
Practice Address - Phone:912-739-3354
Practice Address - Fax:912-739-3374
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2021-05-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA043126207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00782845EMedicaid
GA11BDRCHMedicare ID - Type Unspecified
GA00782845EMedicaid