Provider Demographics
NPI:1982194734
Name:SCOTT, LEAH JEANELLE
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:JEANELLE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 DUNN AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38114-4724
Mailing Address - Country:US
Mailing Address - Phone:901-805-4777
Mailing Address - Fax:901-620-3516
Practice Address - Street 1:2160 DUNN AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38114-4724
Practice Address - Country:US
Practice Address - Phone:901-805-4777
Practice Address - Fax:901-620-3516
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver