Provider Demographics
NPI:1679502934
Name:SCOTT, ANGELA ROYSTER (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:ROYSTER
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3303A GLYNN AVE
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4406
Mailing Address - Country:US
Mailing Address - Phone:912-466-9500
Mailing Address - Fax:912-466-9922
Practice Address - Street 1:3303A GLYNN AVE
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4406
Practice Address - Country:US
Practice Address - Phone:912-466-9500
Practice Address - Fax:912-466-9922
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA59510207W00000X
FLME93299207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA55973885989BMedicaid