Provider Demographics
NPI:1154612125
Name:SCOTT, JENNIFER KING (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KING
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 COPPERFIELD BLVD NE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2441
Mailing Address - Country:US
Mailing Address - Phone:704-721-2063
Mailing Address - Fax:704-789-2090
Practice Address - Street 1:8560 COOK ST
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:NC
Practice Address - Zip Code:28124-7686
Practice Address - Country:US
Practice Address - Phone:704-436-6521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program