Provider Demographics
NPI:1023587706
Name:SCOTT, RAYMOND SELWYN (CAC)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:SELWYN
Last Name:SCOTT
Suffix:
Gender:M
Credentials:CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 MYRTLE CROSSING DR STE 300
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-4429
Mailing Address - Country:US
Mailing Address - Phone:912-243-9310
Mailing Address - Fax:912-243-9311
Practice Address - Street 1:326 MYRTLE CROSSING DR STE 300
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-4429
Practice Address - Country:US
Practice Address - Phone:912-243-9310
Practice Address - Fax:912-243-9311
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-25
Last Update Date:2018-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0853101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0853OtherGEORGIA ADDICTIONS COUNSELOR ASSOCIATION