Provider Demographics
NPI:1477854693
Name:SCOTT, SUSAN PERKINS (RDH)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:PERKINS
Last Name:SCOTT
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 WHITTLE CIR
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:GA
Mailing Address - Zip Code:31714-1918
Mailing Address - Country:US
Mailing Address - Phone:229-567-4316
Mailing Address - Fax:229-567-9271
Practice Address - Street 1:274 WHITTLE CIR
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:GA
Practice Address - Zip Code:31714-1918
Practice Address - Country:US
Practice Address - Phone:229-567-4316
Practice Address - Fax:229-567-9271
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4923124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4923OtherSTATE OF GEORGIA