Provider Demographics
NPI:1528224185
Name:SCOTT ORTHOPAEDIC AND SPINE CENTER LLC
Entity Type:Organization
Organization Name:SCOTT ORTHOPAEDIC AND SPINE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPLE
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:CULLEN
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-537-4411
Mailing Address - Street 1:101 HARRIS INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-8852
Mailing Address - Country:US
Mailing Address - Phone:912-537-4411
Mailing Address - Fax:912-538-8485
Practice Address - Street 1:101 HARRIS INDUSTRIAL BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-8852
Practice Address - Country:US
Practice Address - Phone:912-537-4411
Practice Address - Fax:912-538-8485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057015207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty