Provider Demographics
NPI:1316051683
Name:GILES, SCOTT P (DO)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:P
Last Name:GILES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5000
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37088-5000
Mailing Address - Country:US
Mailing Address - Phone:615-444-2320
Mailing Address - Fax:615-449-3163
Practice Address - Street 1:115 WINWOOD DR STE 205
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-1399
Practice Address - Country:US
Practice Address - Phone:615-444-4126
Practice Address - Fax:855-785-2890
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN818207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3302558Medicaid
TN3302558Medicaid
TN3302551Medicare ID - Type UnspecifiedMEDICARE, CIGNA, PART B