Provider Demographics
NPI:1922762210
Name:SCOTT, RYAN LAMAR
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:LAMAR
Last Name:SCOTT
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 1:2550 COBB PKWY SE STE 203
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-3059
Mailing Address - Country:US
Mailing Address - Phone:678-903-2908
Mailing Address - Fax:
Practice Address - Street 1:2550 COBB PKWY SE STE 203
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-3059
Practice Address - Country:US
Practice Address - Phone:678-903-2908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-24
Last Update Date:2021-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management