Provider Demographics
NPI:1679619183
Name:SNYDER, SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:SNYDER
Suffix:
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 1:1999 PRINCE AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-6013
Mailing Address - Country:US
Mailing Address - Phone:706-543-0059
Mailing Address - Fax:706-543-0290
Practice Address - Street 1:1999 PRINCE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6013
Practice Address - Country:US
Practice Address - Phone:706-543-0059
Practice Address - Fax:706-543-0290
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA279189174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA27918OtherSTATE LICENSE
GA00311363AMedicaid
GA27918OtherSTATE LICENSE
GA26BDHXWMedicare ID - Type Unspecified