Provider Demographics
NPI:1427105758
Name:SCOTT, KELLY JOCELYN-HOUCHIN (AA)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:JOCELYN-HOUCHIN
Last Name:SCOTT
Suffix:
Gender:F
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6335 HOSPITAL PARKWAY
Mailing Address - Street 2:SUITE 111
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097
Mailing Address - Country:US
Mailing Address - Phone:404-778-8311
Mailing Address - Fax:770-495-1585
Practice Address - Street 1:6325 HOSPITAL PARKWAY
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097
Practice Address - Country:US
Practice Address - Phone:404-778-8311
Practice Address - Fax:770-495-1585
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA004123367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA861528604AMedicaid
GA861528604AMedicaid