Provider Demographics
NPI:1255443800
Name:PERDUE, SCOTT PATRICK (PA-AA)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:PATRICK
Last Name:PERDUE
Suffix:
Gender:M
Credentials:PA-AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5353 REYNOLDS ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6015
Mailing Address - Country:US
Mailing Address - Phone:912-819-6000
Mailing Address - Fax:
Practice Address - Street 1:5353 REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6015
Practice Address - Country:US
Practice Address - Phone:912-819-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3701367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003109640BMedicaid
SC1DGAN385Medicaid
GA003109640AMedicaid
GA003109640DMedicaid
GAP00953042OtherRAILROAD MEDICARE
GA003109640CMedicaid
GA592779OtherWELLCARE
GA580628385OtherTRICARE
GA873397113AMedicaid
GA592779OtherWELLCARE
GA003109640CMedicaid