| Organization Name: | D W SCARBOROUGH M D P C |
| NPI Number: | 1316145311 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAVID SCARBOROUGH (OWNER) |
| Mailing Address: | 121 N Caswell St Glennville |
| State: | GA US |
| Postal Code: | 304272017 |
| Phone Number: | 9126541080 |
| Fax Number: | 9126541090 |
| NPI Enumeration Date: | 07/11/2007 |
| NPI Last Update Date: | 07/11/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QH0100X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | |