Provider Demographics
NPI:1932499159
Name:SCIARRINO, NATALIE VERCILLO (MD)
Entity Type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:VERCILLO
Last Name:SCIARRINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:CANNON
Other - Last Name:VERCILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 EXCHANGE DR
Mailing Address - Street 2:
Mailing Address - City:LUGOFF
Mailing Address - State:SC
Mailing Address - Zip Code:29078-9198
Mailing Address - Country:US
Mailing Address - Phone:803-424-2207
Mailing Address - Fax:803-408-3282
Practice Address - Street 1:4150 DEPUTY BILL CANTRELL MEMORIAL ROAD
Practice Address - Street 2:SUITE 260
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-9198
Practice Address - Country:US
Practice Address - Phone:770-292-3045
Practice Address - Fax:770-292-3046
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC39286207Y00000X
390200000X
GA98417207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC392863Medicaid