Provider Demographics
NPI:1841305679
Name:BERRY, SCOTT MORRIS (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:MORRIS
Last Name:BERRY
Suffix:
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 1:506 E CHEVES ST STE 202
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29506-2616
Mailing Address - Country:US
Mailing Address - Phone:843-777-5091
Mailing Address - Fax:843-777-5572
Practice Address - Street 1:4000 HIGHWAY 9 E STE 245
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-7833
Practice Address - Country:US
Practice Address - Phone:843-366-2940
Practice Address - Fax:843-366-2470
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14869208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS000116846Medicaid
MS020000324Medicare PIN
MSG35365Medicare UPIN
MS000116846Medicaid