Healthcare Provider Details

I. General information

NPI: 1407823099
Provider Name (Legal Business Name): SCOTT ACKLIN MATTHEWS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2006
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 SOMERVILLE RD SE
DECATUR AL
35601-4340
US

IV. Provider business mailing address

1201 SOMERVILLE RD SE
DECATUR AL
35601-4340
US

V. Phone/Fax

Practice location:
  • Phone: 256-584-8038
  • Fax: 256-584-8136
Mailing address:
  • Phone: 256-584-8038
  • Fax: 256-584-8136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD25714
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25714
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: