Provider Demographics
NPI:1881686384
Name:BARBOUR, SCOTT ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:ALLEN
Last Name:BARBOUR
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 1:4408 LOCHSA LANE
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1738
Mailing Address - Country:US
Mailing Address - Phone:404-775-1191
Mailing Address - Fax:
Practice Address - Street 1:BARBOUR ORTHOPAEDICS AND SPORTS MEDICINE
Practice Address - Street 2:3240 NORTHEAST EXPRESSWAY SUITE 100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341
Practice Address - Country:US
Practice Address - Phone:404-480-9330
Practice Address - Fax:404-480-9330
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD28004207X00000X
GA051908207XX0005X
GA51908207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR218405Medicaid
OR140358Medicare PIN
OR218405Medicaid