Basic Information
| Provider Information | |||||||||
| NPI: | 1346208154 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCOTT | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1818 HENDERSON ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292012647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037582600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 645 S SEVENTH ST | ||||||||
| Address2: | |||||||||
| City: | MC BEE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291017101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8439036650 | ||||||||
| FaxNumber: | 8439030758 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2006 | ||||||||
| LastUpdateDate: | 12/07/2017 | ||||||||
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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 | 207Q00000X | 14239 | SC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | TL2743 | 05 | SC | MEDICAID |