Individual
DR. SCOTT DONALD GARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
340 BRANDYWINE BLVD, FAYETTEVILLE, GA 30214-1562
(770) 719-7950
(770) 460-1739
Mailing address
340 BRANDYWINE BLVD, FAYETTEVILLE, GA 30214-1562
(770) 719-7950
(770) 460-1739
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
075189
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003175035A
—
GA
01
—
202I183334
MEDICARE PTAN
GA
Enumeration date
06/13/2012
Last updated
03/08/2019
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