Healthcare Provider Details

I. General information

NPI: 1487687745
Provider Name (Legal Business Name): HOWARD SCOTT TACKETT P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1412 ELBA HWY
TROY AL
36079-6020
US

IV. Provider business mailing address

1414 ELBA HWY
TROY AL
36079-6020
US

V. Phone/Fax

Practice location:
  • Phone: 334-566-8822
  • Fax: 334-670-2081
Mailing address:
  • Phone: 334-670-6726
  • Fax: 334-670-6731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number422
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA-422
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: