Provider Demographics
NPI:1184694168
Name:COLEY, SCOTT A (M D)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:A
Last Name:COLEY
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:120 HEYWOOD AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-1210
Practice Address - Country:US
Practice Address - Phone:864-573-9595
Practice Address - Fax:864-585-3752
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16753207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC58884OtherMEDCOST
SC167535Medicaid
NC7906538Medicaid
SC4675093OtherAETNA
NC7906538Medicaid
SCF87706Medicare PIN