Individual provider Active NPI

Scott Allen Bickerton, NP

  • Nurse Practitioner
  • Lawrenceville, GA
National Provider Identifier
1104482322
Registry record updated May 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN240223 Issued in GA
Practice address
4835 Sugarloaf Pkwy Ste 200
Lawrenceville, GA 30044-6916
Phone
(470) 206-0887
NPI assigned
May 13, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X RN240223 GA Primary

Addresses

Primary practice location

4835 Sugarloaf Pkwy Ste 200
Lawrenceville, GA 30044-6916

Mailing address

390 Hembree Forest Cir
Roswell, GA 30076-1198

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220930002670 GA Practitioner - Nurse Practitioner 0244616027 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Restor Diabetes Care LLCGroup PAC ID 7911362363, 3 clinicians

Practice addresses (Care Compare)

300 Parkbrooke PL
Suite 150
Woodstock, GA 30189-7280
Phone (678) 426-8311

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Restorathens, LLC CurrentSince Sep 22, 2022 Accepting new patients
Restor Diabetes Care LLC CurrentSince May 1, 2023 Accepting new patients

Locations

394 S Milledge Ave
Athens, GA 30605
Phone (470) 767-0443

2151 Homer Rd
Ste 130
Commerce, GA 30529
Phone (678) 426-8311

300 Parkbrooke Pl
Ste 150
Woodstock, GA 30189
Phone (678) 426-8311

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1557705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557705600000",
    "number": "1104482322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "390 HEMBREE FOREST CIR",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300761198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4835 SUGARLOAF PKWY STE 200",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300446916",
            "telephone_number": "470-206-0887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BICKERTON",
        "first_name": "SCOTT",
        "middle_name": "ALLEN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-05-13",
        "last_updated": "2019-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN240223",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

Verify at the official NPI Registry.