Provider Demographics
NPI:1477874683
Name:GADLIN, SCOTTY LANE (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTTY
Middle Name:LANE
Last Name:GADLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 SUNSET DR STE 503
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2288
Mailing Address - Country:US
Mailing Address - Phone:706-850-1771
Mailing Address - Fax:331-204-0769
Practice Address - Street 1:700 SUNSET DR STE 503
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2288
Practice Address - Country:US
Practice Address - Phone:706-850-1771
Practice Address - Fax:331-204-0769
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-22
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4208207R00000X
GA72589207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I183520Medicare PIN