Healthcare Provider Details

I. General information

NPI: 1639158389
Provider Name (Legal Business Name): SCOTT M ACKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 01/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6240 SHILOH RD STE B
ALPHARETTA GA
30005-8347
US

IV. Provider business mailing address

6240 SHILOH RD
ALPHARETTA GA
30005-8347
US

V. Phone/Fax

Practice location:
  • Phone: 678-208-2165
  • Fax:
Mailing address:
  • Phone: 678-208-2165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number24371
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number24371
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: