Provider Demographics
NPI:1972194520
Name:SCOTT, LEROY JR (MD,MPH)
Entity Type:Individual
Prefix:DR
First Name:LEROY
Middle Name:
Last Name:SCOTT
Suffix:JR
Gender:M
Credentials:MD,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3818 LARAMIE RD
Mailing Address - Street 2:
Mailing Address - City:ELLENWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30294-6651
Mailing Address - Country:US
Mailing Address - Phone:770-468-0123
Mailing Address - Fax:
Practice Address - Street 1:4030 CHOUTEAU AVE FL 4
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1754
Practice Address - Country:US
Practice Address - Phone:314-696-2090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-27
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health