Provider Demographics
NPI:1023560893
Name:SCOTT, PHYLISS D
Entity Type:Individual
Prefix:MS
First Name:PHYLISS
Middle Name:D
Last Name:SCOTT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 LEIGHTON AVE
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-5786
Mailing Address - Country:US
Mailing Address - Phone:256-237-6245
Mailing Address - Fax:256-237-6719
Practice Address - Street 1:822 LEIGHTON AVE
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5786
Practice Address - Country:US
Practice Address - Phone:256-237-6245
Practice Address - Fax:256-237-6719
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician