Provider Demographics
NPI:1851382444
Name:ADKISSON, SCOTT L
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:L
Last Name:ADKISSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 HIGHWAY 321 N
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37771-5012
Mailing Address - Country:US
Mailing Address - Phone:865-986-6566
Mailing Address - Fax:
Practice Address - Street 1:603 HIGHWAY 321 N
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37771-6575
Practice Address - Country:US
Practice Address - Phone:865-986-6566
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS7867122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN748082OtherUNITED CONCORDIA
TN4024874OtherBLUE CROSS BLUE SHIELD