Provider Demographics
NPI:1457147977
Name:MCCOY SCRIVEN, FAITH
Entity type:Individual
Prefix:
First Name:FAITH
Middle Name:
Last Name:MCCOY SCRIVEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 W BROOKHAVEN DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319-1143
Mailing Address - Country:US
Mailing Address - Phone:646-620-5164
Mailing Address - Fax:
Practice Address - Street 1:2700 COBB PKWY SE STE B-15
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-3025
Practice Address - Country:US
Practice Address - Phone:678-916-6745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management