Provider Demographics
NPI:1871564252
Name:SCOTT, ERICA Y (MD)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:Y
Last Name:SCOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4181 HOSPITAL DR NE STE 303
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-2541
Mailing Address - Country:US
Mailing Address - Phone:678-471-0128
Mailing Address - Fax:
Practice Address - Street 1:4181 HOSPITAL DR NE STE 303
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2541
Practice Address - Country:US
Practice Address - Phone:678-471-0128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA076869208600000X
WAMD00047212208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4771500Medicaid
MI17-00312OtherPHP
MI700A910020OtherBCBS
MI7755233OtherAETNA
MI0201914342OtherBCN
MICC2666OtherRAILROAD MEDICARE
MI4771500Medicaid