Provider Demographics
NPI:1609656602
Name:SCOTT, ALICIA NICOLE (PMHNP)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:NICOLE
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:NICOLE
Other - Last Name:CHARLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:255 CORPORATE CENTER DR STE C
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7376
Mailing Address - Country:US
Mailing Address - Phone:470-526-8929
Mailing Address - Fax:
Practice Address - Street 1:255 CORPORATE CENTER DR STE C
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7376
Practice Address - Country:US
Practice Address - Phone:470-526-8929
Practice Address - Fax:470-771-5406
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-05
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN277064363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health