Provider Demographics
NPI:1790981645
Name:SCAIFE, DARRELL WINSTON (MMP, BCTMB)
Entity Type:Individual
Prefix:MR
First Name:DARRELL
Middle Name:WINSTON
Last Name:SCAIFE
Suffix:
Gender:M
Credentials:MMP, BCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 SANDY PLAINS RD, STE 225 #333
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-7256
Mailing Address - Country:US
Mailing Address - Phone:770-910-0341
Mailing Address - Fax:
Practice Address - Street 1:2410 BOB BETTIS RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-5712
Practice Address - Country:US
Practice Address - Phone:704-526-7112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT000522174400000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174400000XOther Service ProvidersSpecialist