Provider Demographics
NPI:1407823099
Name:MATTHEWS, SCOTT ACKLIN (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:ACKLIN
Last Name:MATTHEWS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 SOMERVILLE RD SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-4340
Mailing Address - Country:US
Mailing Address - Phone:256-584-8038
Mailing Address - Fax:256-584-8136
Practice Address - Street 1:1201 SOMERVILLE RD SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-4340
Practice Address - Country:US
Practice Address - Phone:256-584-8038
Practice Address - Fax:256-584-8136
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL25714207R00000X
ALMD25714207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51529627OtherBCBS
AL009934102Medicaid
AL110635Medicaid
AL051556392Medicare ID - Type Unspecified
AL009934102Medicaid
AL102I115011Medicare PIN