Provider Demographics
NPI:1851320501
Name:POWERS, THEODORE SCOTT (MD)
Entity Type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:SCOTT
Last Name:POWERS
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:PO BOX 870
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35056-0870
Mailing Address - Country:US
Mailing Address - Phone:256-736-8998
Mailing Address - Fax:256-736-8588
Practice Address - Street 1:1942 AL HWY 157
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058
Practice Address - Country:US
Practice Address - Phone:256-736-8998
Practice Address - Fax:256-736-8588
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21862208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051500645Medicaid
AL000948666Medicaid
ALP00389542OtherRAILROAD MEDICARE
AL051500645Medicaid