Provider Demographics
NPI:1730793761
Name:NORTON, SCOTT L
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:L
Last Name:NORTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1079 MARIETTA BLVD NW UNIT 7
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-4982
Mailing Address - Country:US
Mailing Address - Phone:706-338-2237
Mailing Address - Fax:
Practice Address - Street 1:1079 MARIETTA BLVD NW UNIT 7
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-4982
Practice Address - Country:US
Practice Address - Phone:706-338-2237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT012711225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist