Provider Demographics
NPI:1619316106
Name:SCOTT, EDGAR LEONARD III (MD)
Entity Type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:LEONARD
Last Name:SCOTT
Suffix:III
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 1:254 PEACHTREE ST SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-3731
Mailing Address - Country:US
Mailing Address - Phone:404-625-9098
Mailing Address - Fax:404-344-0211
Practice Address - Street 1:254 PEACHTREE ST SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3731
Practice Address - Country:US
Practice Address - Phone:404-865-8001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA49608207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine