Individual
SCOTT PROVOST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LDO
Contact information
Practice address
4375 LEXINGTON RD, ATHENS, GA 30605-2525
(706) 355-3142
(706) 355-3820
Mailing address
4375 LEXINGTON RD, ATHENS, GA 30605-2525
(706) 355-3142
(706) 355-3820
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
—
—
Other
Enumeration date
05/01/2023
Last updated
05/01/2023
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