Provider Demographics
NPI:1639158389
Name:ACKER, SCOTT M (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:M
Last Name:ACKER
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 1:6240 SHILOH RD
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-8347
Mailing Address - Country:US
Mailing Address - Phone:678-208-2165
Mailing Address - Fax:
Practice Address - Street 1:6240 SHILOH RD STE B
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-8347
Practice Address - Country:US
Practice Address - Phone:678-208-2165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL24371207ZD0900X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL193679419AMedicaid
PA102409289-0001Medicaid
GA003118339AMedicaid
MD4421906 00Medicaid
NJ228458YC40Medicare PIN
GA003118339AMedicaid
MD4421906 00Medicaid
MD222152YEZXMedicare PIN
GA511I220057Medicare PIN
AL193679419AMedicaid
SCAA59929282Medicare PIN
FLEQ877ZMedicare PIN
NC2077067Medicare PIN
PA170720V4BMedicare PIN