Provider Demographics
NPI:1740467398
Name:SCOGLIETTI, VINCENT C III (MD)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:C
Last Name:SCOGLIETTI
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:706 DIXIE ST STE 130
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3859
Mailing Address - Country:US
Mailing Address - Phone:770-812-5886
Mailing Address - Fax:770-838-1027
Practice Address - Street 1:706 DIXIE ST STE 130
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3859
Practice Address - Country:US
Practice Address - Phone:770-812-5886
Practice Address - Fax:770-838-1027
Is Sole Proprietor?:No
Enumeration Date:2008-01-25
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA68788208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003137817AMedicaid
GA202I020053Medicare PIN