Provider Demographics
NPI:1497802581
Name:SCOTT, COLETTE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:COLETTE
Middle Name:MARIE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1668 WEST PEACE STREET
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-0588
Mailing Address - Country:US
Mailing Address - Phone:662-746-0907
Mailing Address - Fax:
Practice Address - Street 1:1668 WEST PEACE STREET
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-4500
Practice Address - Country:US
Practice Address - Phone:662-746-0907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17998207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP00634038OtherRR MEDICARE PTAN
MS07088805Medicaid
MSH92768Medicare UPIN
MS080005083Medicare PIN
MSP00634038OtherRR MEDICARE PTAN