Provider Demographics
NPI:1386667152
Name:SCOTT, WAYNE MARTIN (DO)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:MARTIN
Last Name:SCOTT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:162 CADE ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:HARTWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30643
Mailing Address - Country:US
Mailing Address - Phone:706-856-6970
Mailing Address - Fax:706-856-6972
Practice Address - Street 1:162 CADE ST
Practice Address - Street 2:SUITE D
Practice Address - City:HARTWELL
Practice Address - State:GA
Practice Address - Zip Code:30643
Practice Address - Country:US
Practice Address - Phone:706-856-6970
Practice Address - Fax:706-856-6972
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9604207Q00000X
GA58820207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA697440072AMedicaid