Basic Information
| Provider Information | |||||||||
| NPI: | 1164477337 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 NORTHSIDE FORSYTH DR | ||||||||
| Address2: | SUITE 340 | ||||||||
| City: | CUMMING | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300416012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708868111 | ||||||||
| FaxNumber: | 7702058539 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 NORTHSIDE FORSYTH DR | ||||||||
| Address2: | SUITE 340 | ||||||||
| City: | CUMMING | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300416012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708868111 | ||||||||
| FaxNumber: | 7702058539 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 11/03/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 003854 | GA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363A00000X | 003854 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.