Provider Demographics
NPI:1649344938
Name:SCOTT, TELICIA DEQUAI (PA-C)
Entity type:Individual
Prefix:MRS
First Name:TELICIA
Middle Name:DEQUAI
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4153B FLAT SHOALS PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-4189
Mailing Address - Country:US
Mailing Address - Phone:404-585-5049
Mailing Address - Fax:404-591-0292
Practice Address - Street 1:4153B FLAT SHOALS PKWY STE 200
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-4189
Practice Address - Country:US
Practice Address - Phone:404-585-5049
Practice Address - Fax:404-591-0292
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2018-03-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA004435363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical