Provider Demographics
NPI:1386636132
Name:SMITH, SCARLETTE D (MD)
Entity Type:Individual
Prefix:
First Name:SCARLETTE
Middle Name:D
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 MAIN AVE SW
Mailing Address - Street 2:SUITE B
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055-7206
Mailing Address - Country:US
Mailing Address - Phone:256-739-8260
Mailing Address - Fax:256-739-8263
Practice Address - Street 1:1705 MAIN AVE SW
Practice Address - Street 2:SUITE B
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-7206
Practice Address - Country:US
Practice Address - Phone:256-739-8260
Practice Address - Fax:256-739-8263
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2008-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15896207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALE84992Medicare UPIN