Healthcare Provider Details

I. General information

NPI: 1629094982
Provider Name (Legal Business Name): MATTIE MARY SANDRA SCOTT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8423 HOLLY RD STE B
GRAND BLANC MI
48439-2488
US

IV. Provider business mailing address

8423 HOLLY RD STE B
GRAND BLANC MI
48439-2488
US

V. Phone/Fax

Practice location:
  • Phone: 810-694-7095
  • Fax: 810-694-7224
Mailing address:
  • Phone: 810-694-7095
  • Fax: 810-694-7224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number4301075129
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301075129
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: