Provider Demographics
NPI:1912994344
Name:LEVERE, SCOTT M (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:M
Last Name:LEVERE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2041 MESA VALLEY WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-8157
Mailing Address - Country:US
Mailing Address - Phone:770-944-1100
Mailing Address - Fax:770-944-6469
Practice Address - Street 1:2041 MESA VALLEY WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-8157
Practice Address - Country:US
Practice Address - Phone:770-944-1100
Practice Address - Fax:770-944-6469
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2009-02-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA037017207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000553814FMedicaid
GA000553814DMedicaid
GA000553814EMedicaid
GA000553814BMedicaid
GA000553814FMedicaid
GA000553814EMedicaid