Individual
ROBERT SCANLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1811 EDWINA DR, VIDALIA, GA 30474-8963
(912) 538-8105
(912) 538-8109
Mailing address
PO BOX 407, VIDALIA, GA 30475-0407
(912) 537-4986
(912) 538-8109
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
65886
GA
207RP1001X
Pulmonary Disease Physician
Primary
65886
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003107027A
—
GA
01
—
2K3975
HEALTHNET
—
01
—
3263210
AETNA
—
01
—
9392179
CIGNA
—
01
—
P2754298
OXFORD
—
Enumeration date
07/08/2005
Last updated
06/20/2025
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