Healthcare Provider Details

I. General information

NPI: 1528404597
Provider Name (Legal Business Name): ADAM WESLEY SCOTT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2013
Last Update Date: 04/07/2020
Certification Date: 04/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4154 CARMICHAEL RD
MONTGOMERY AL
36106-2866
US

IV. Provider business mailing address

1722 PINE ST STE 203
MONTGOMERY AL
36106-1158
US

V. Phone/Fax

Practice location:
  • Phone: 334-271-5959
  • Fax: 334-272-8775
Mailing address:
  • Phone: 334-293-8736
  • Fax: 334-293-8738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number267412
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD.33975
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: