Healthcare Provider Details

I. General information

NPI: 1447238951
Provider Name (Legal Business Name): SCOTT ASHLEY CHARLTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 01/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E BRUNSON ST SUITE 102
ENTERPRISE AL
36330-2526
US

IV. Provider business mailing address

PO BOX 311105
ENTERPRISE AL
36331-1105
US

V. Phone/Fax

Practice location:
  • Phone: 334-308-9368
  • Fax: 334-308-3277
Mailing address:
  • Phone: 334-308-9368
  • Fax: 334-393-7011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number22530
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number22530
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number22530
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number22530
License Number StateAL
# 5
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number22530
License Number StateAL
# 6
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number22530
License Number StateAL
# 7
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number22530
License Number StateAL
# 8
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number22530
License Number StateAL
# 9
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD.22530
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: