Provider Demographics
NPI:1942362868
Name:LEETH, SCOTT CHRISTOPHER (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:CHRISTOPHER
Last Name:LEETH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3500 MCCLURE BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-3131
Mailing Address - Country:US
Mailing Address - Phone:770-476-3636
Mailing Address - Fax:770-476-5845
Practice Address - Street 1:3500 MCCLURE BRIDGE RD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-3131
Practice Address - Country:US
Practice Address - Phone:770-476-3636
Practice Address - Fax:770-476-5845
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038842207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000659095FMedicaid
F57754Medicare UPIN
GA000659095FMedicaid