Provider Demographics
NPI:1528201282
Name:SCOTT, RANDALL A
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:A
Last Name:SCOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2921 PIEDMONT RD NE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-2785
Mailing Address - Country:US
Mailing Address - Phone:404-633-2334
Mailing Address - Fax:404-760-1136
Practice Address - Street 1:1996 CLIFF VALLEY WAY NE
Practice Address - Street 2:SUITE 106
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2449
Practice Address - Country:US
Practice Address - Phone:404-633-2334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC 1620101YP2500X
GALMFT 829106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional