Provider Demographics
NPI:1902861123
Name:SCOTT, CHRISTINE R (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:R
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:D
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3495 PIEDMONT ROAD, NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305
Mailing Address - Country:US
Mailing Address - Phone:404-504-5678
Mailing Address - Fax:870-535-4716
Practice Address - Street 1:3550 PRESTON RIDGE ROAD
Practice Address - Street 2:KAISER PERMANENTE ALPHARETTA MEDICAL CENTER
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005
Practice Address - Country:US
Practice Address - Phone:770-663-3110
Practice Address - Fax:870-535-4716
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-3560207Q00000X
GA075547207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR149592001Medicaid
ARH77387OtherUPIN
AR5M449OtherMEDICARE