Provider Demographics
NPI:1174716146
Name:EMELY, SCOTT T (OD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:T
Last Name:EMELY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4330 JOHNS CREEK PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6047
Mailing Address - Country:US
Mailing Address - Phone:770-232-7844
Mailing Address - Fax:770-232-9455
Practice Address - Street 1:4330 JOHNS CREEK PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6047
Practice Address - Country:US
Practice Address - Phone:770-232-7844
Practice Address - Fax:770-232-9455
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA2336152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511I410012OtherPTAN
GAGRP4578Medicare PIN