Individual
DR. SCOTT M STEPHEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 W ACADEMY STREET, GAINESVILLE, GA 30501
(770) 282-8820
Mailing address
PO BOX 2417, GAINESVILLE, GA 30503-2417
(770) 532-9936
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
39952
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000660822AC
—
GA
05
—
000660822AU
—
GA
01
—
581177261A
GA MEDICARE GRP PROV #
GA
01
—
P0031463
RAILROAD MEDICARE
GA
Enumeration date
11/18/2005
Last updated
01/13/2021
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