Provider Demographics
NPI:1902102981
Name:SCOTT, DONNIE JUNOR
Entity Type:Individual
Prefix:
First Name:DONNIE
Middle Name:JUNOR
Last Name:SCOTT
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 1:214 FARLEY RD
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:NC
Mailing Address - Zip Code:28326-9797
Mailing Address - Country:US
Mailing Address - Phone:919-721-3938
Mailing Address - Fax:919-499-9519
Practice Address - Street 1:214 FARLEY RD
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:NC
Practice Address - Zip Code:28326-9797
Practice Address - Country:US
Practice Address - Phone:919-721-3938
Practice Address - Fax:919-499-9519
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30103132344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi