Doctor Name: | MR. JOHNNY KEITH SCOTT |
NPI Number: | 1417091067 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | P.A. |
License Number: | 1946 |
Business Practice Address: | 392 7th St Atlantic Beach, FL - 322335434 |
Business Phone Number: | 9042704220 |
Business Fax Number: | |
Mailing Address: | 392 7th St, ATLANTIC BEACH |
State: | FL |
Postal Code: | 322335434 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 02/16/2007 |
NPI Last Update Date: | 05/20/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 1946 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |