Provider Demographics
NPI:1932662251
Name:SCOTT, JUSTINE (PNP)
Entity Type:Individual
Prefix:MS
First Name:JUSTINE
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 CENTENNIAL OLYMPIC PARK DR NW UNIT 1515
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30313-1954
Mailing Address - Country:US
Mailing Address - Phone:205-383-5963
Mailing Address - Fax:
Practice Address - Street 1:6010 SINGLETON RD STE 209
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-1963
Practice Address - Country:US
Practice Address - Phone:770-248-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN251450363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics