Healthcare Provider Details

I. General information

NPI: 1033357744
Provider Name (Legal Business Name): SCOTT A. CHARLTON, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2009
Last Update Date: 03/10/2009
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: 334-393-2353
  • Fax:
Mailing address:
  • Phone: 334-393-2353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. SCOTT ASHLEY CHARLTON
Title or Position: OWNER
Credential: MD
Phone: 334-393-2353