Provider Demographics
NPI:1679577456
Name:SCOTT, CARL DEAN (CRNA)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:DEAN
Last Name:SCOTT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 LAKEMONT DR
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-8231
Mailing Address - Country:US
Mailing Address - Phone:803-932-7936
Mailing Address - Fax:
Practice Address - Street 1:561 LAKEMONT DR
Practice Address - Street 2:
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036-8231
Practice Address - Country:US
Practice Address - Phone:803-932-7936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered