Provider Demographics
NPI:1972622181
Name:DOVE, SCOTTY GARLAND (DO)
Entity Type:Individual
Prefix:DR
First Name:SCOTTY
Middle Name:GARLAND
Last Name:DOVE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 HOLSTON RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-4486
Mailing Address - Country:US
Mailing Address - Phone:276-227-0460
Mailing Address - Fax:276-227-0466
Practice Address - Street 1:245 HOLSTON RD
Practice Address - Street 2:SUITE B
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-4486
Practice Address - Country:US
Practice Address - Phone:276-227-0460
Practice Address - Fax:276-227-0466
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102050091207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1972622181Medicaid
F92055Medicare UPIN
VA1972622181Medicaid