Provider Demographics
NPI:1750397295
Name:ANDERSON, SCOTT W (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:W
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11700 MERCY BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-1753
Mailing Address - Country:US
Mailing Address - Phone:912-927-3434
Mailing Address - Fax:912-927-5016
Practice Address - Street 1:ST. JOSEPH'S CARDIOLOGY GROUP LLC
Practice Address - Street 2:11700 MERCY BLVD, PLAZA D, BLDG 6
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419
Practice Address - Country:US
Practice Address - Phone:912-927-3434
Practice Address - Fax:912-927-5016
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2021-12-10
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA20649207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000221317N,I,J,L,MMedicaid
GAA98350Medicare UPIN
GA06BDDTJMedicare ID - Type Unspecified