Provider Demographics
NPI:1306839808
Name:SCOTT, ALBERT JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:
Last Name:SCOTT
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1458 CHURCH ST STE B
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-1672
Mailing Address - Country:US
Mailing Address - Phone:404-508-5012
Mailing Address - Fax:404-377-0550
Practice Address - Street 1:1458 CHURCH ST STE B
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1672
Practice Address - Country:US
Practice Address - Phone:404-508-2000
Practice Address - Fax:404-377-0550
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032293207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000403653CMedicaid
GA000403653HMedicaid
GA16BDCBXMedicare PIN
GA000403653CMedicaid