Provider Demographics
NPI:1730155037
Name:SCOTT, WAYNE T (MD)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:T
Last Name:SCOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1030
Mailing Address - Street 2:GALEN MEDICAL GROUP
Mailing Address - City:CHATT
Mailing Address - State:TN
Mailing Address - Zip Code:37401
Mailing Address - Country:US
Mailing Address - Phone:423-894-3725
Mailing Address - Fax:423-954-9019
Practice Address - Street 1:2051 HAMILL RD
Practice Address - Street 2:GALEN MEDICAL GROUP S-204
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343
Practice Address - Country:US
Practice Address - Phone:423-870-2450
Practice Address - Fax:423-877-5208
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN15657207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A98277Medicare UPIN
TN3019008Medicare ID - Type Unspecified