Provider Demographics
NPI:1669723748
Name:SCOTT, JOHN LUCAS (CRNA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:LUCAS
Last Name:SCOTT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 OLD ROCKY RIDGE RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216-7235
Mailing Address - Country:US
Mailing Address - Phone:205-989-1080
Mailing Address - Fax:205-989-1087
Practice Address - Street 1:315 W HICKORY ST
Practice Address - Street 2:
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-2913
Practice Address - Country:US
Practice Address - Phone:256-401-4605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-28
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-114177367500000X
TN16952367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered