Provider Demographics
NPI:1952364192
Name:ROMAN, SCOTT R (DPM)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:R
Last Name:ROMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 HWY 54 W
Mailing Address - Street 2:STE 205
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-4794
Mailing Address - Country:US
Mailing Address - Phone:678-561-9000
Mailing Address - Fax:770-487-1232
Practice Address - Street 1:1975 HIGHWAY 54 W
Practice Address - Street 2:STE 205
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-4794
Practice Address - Country:US
Practice Address - Phone:678-561-9000
Practice Address - Fax:770-487-1232
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001026213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA127289526BMedicaid
GA202I489463OtherMEDICARE PTAN
GA127289526CMedicaid
GA127289526DMedicaid
GA127289526EMedicaid