Basic Information
Provider Information
NPI: 1386892990
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCOTT
FirstName: ZAKIYA
MiddleName: T
NamePrefix: DR.
NameSuffix:  
Credential: DDS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 400 GALLERIA PKWY SE
Address2: SUITE 800
City: ATLANTA
State: GA
PostalCode: 303395980
CountryCode: US
TelephoneNumber: 7709165362
FaxNumber: 7702346642
Practice Location
Address1: 1900 N BROADWAY
Address2: SUITE 102
City: BALTIMORE
State: MD
PostalCode: 212131444
CountryCode: US
TelephoneNumber: 4439571602
FaxNumber: 4102353202
Other Information
ProviderEnumerationDate: 09/08/2008
LastUpdateDate: 02/28/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223G0001X14202MDY Dental ProvidersDentistGeneral Practice

No ID Information.


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