NPIMap

Individual provider Active NPI

Telicia Dequai Scott, PA-C

  • Medical Physician Assistant
  • Decatur, GA
National Provider Identifier
1649344938
Registry record updated Mar 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
004435 Issued in GA
Practice address
4153B Flat Shoals Pkwy Ste 200
Decatur, GA 30034-4189
Phone
(404) 585-5049
Fax
(404) 591-0292
NPI assigned
Nov 20, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 15, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 004435 GA Primary

Addresses

Primary practice location

4153B Flat Shoals Pkwy Ste 200
Decatur, GA 30034-4189

Mailing address

4153B Flat Shoals Pkwy Ste 200
Decatur, GA 30034-4189
Phone (404) 585-5049

Other practice location 1

1046 Ridge Ave SW
Atlanta, GA 30315-1640
Phone (404) 688-1350

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140307001215 GA Practitioner - Physician Assistant 2668602806 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Midwestern University College of Dental Medicine, Glendale, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Emory Specialty Associates, LLCGroup PAC ID 3476559782, 706 clinicians

Practice addresses (Care Compare)

1821 Clifton Rd NE
Atlanta, GA 30329-4021
Phone (404) 728-6812

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
004435GAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southside Medical Center, Inc CurrentSince Jan 11, 2014 Accepting new patients
Southside Medical Center, Inc. CurrentSince Jan 11, 2014 Accepting new patients
The Emory Clinic Inc CurrentSince May 29, 2020 Accepting new patients

Locations

2201 Henderson Mill Rd NE
Ste 160
Atlanta, GA 30345
Phone (404) 251-2193

1046 Ridge Ave SW
Atlanta, GA 30315
Phone (404) 564-6942

1039 Ridge Ave SW
Atlanta, GA 30315
Phone (407) 761-8640

1365 Clifton Rd NE
Atlanta, GA 30322
Phone (404) 778-7525

Interoperability endpoints

  • Direct secure messaging: tscott53266@direct.emory.org

Organizations & group practices 4

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521072000000",
    "number": "1649344938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4153B FLAT SHOALS PKWY STE 200",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300344189",
            "telephone_number": "404-585-5049",
            "fax_number": "404-591-0292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4153B FLAT SHOALS PKWY STE 200",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300344189",
            "telephone_number": "404-585-5049",
            "fax_number": "404-591-0292"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1046 Ridge Ave SW",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303151640",
            "country_code": "US",
            "telephone_number": "404-688-1350",
            "fax_number": "404-688-2962",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SCOTT",
        "first_name": "TELICIA",
        "middle_name": "DEQUAI",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-20",
        "last_updated": "2018-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "004435",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, GA

Sources for this page

Verify at the official NPI Registry.