Basic Information
Provider Information
NPI: 1760485916
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LAMPERT
FirstName: SCOTT
MiddleName: I
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1100 JOHNSON FERRY RD NE
Address2: SUITE 593
City: ATLANTA
State: GA
PostalCode: 303421709
CountryCode: US
TelephoneNumber: 4042559096
FaxNumber: 4042559097
Practice Location
Address1: 1100 JOHNSON FERRY RD NE
Address2: SUITE 593
City: ATLANTA
State: GA
PostalCode: 303421709
CountryCode: US
TelephoneNumber: 4042559096
FaxNumber: 4042559097
Other Information
ProviderEnumerationDate: 05/23/2005
LastUpdateDate: 02/12/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207W00000X017229GAY Allopathic & Osteopathic PhysiciansOphthalmology 

No ID Information.


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