Provider Demographics
NPI:1023710308
Name:SCOTT, WALTER HUE II
Entity type:Individual
Prefix:MR
First Name:WALTER
Middle Name:HUE
Last Name:SCOTT
Suffix:II
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 1:1819 27TH ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36854-2755
Mailing Address - Country:US
Mailing Address - Phone:706-402-0296
Mailing Address - Fax:706-837-0035
Practice Address - Street 1:2233 WEST POINT RD.
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240
Practice Address - Country:US
Practice Address - Phone:706-837-0045
Practice Address - Fax:706-837-0035
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC008994101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty