Provider Demographics
NPI:1063540110
Name:SCOTT, CHARLES FREDERICK (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:FREDERICK
Last Name:SCOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4279 ROSWELL RD
Mailing Address - Street 2:#254
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-3769
Mailing Address - Country:US
Mailing Address - Phone:770-431-8511
Mailing Address - Fax:770-431-8411
Practice Address - Street 1:2812 SPRING RD SE
Practice Address - Street 2:#200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-3037
Practice Address - Country:US
Practice Address - Phone:770-431-8511
Practice Address - Fax:770-431-8411
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2010-06-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA028884207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511I110294Medicare UPIN
GA11BDBVRMedicare UPIN
GA511G700201Medicare PIN
GA202I118109Medicare UPIN