Provider Demographics
NPI:1881615029
Name:TWILLEY, SCOTTIE LYNN (DO)
Entity type:Individual
Prefix:DR
First Name:SCOTTIE
Middle Name:LYNN
Last Name:TWILLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:AL
Mailing Address - Zip Code:35550-6000
Mailing Address - Country:US
Mailing Address - Phone:205-483-8140
Mailing Address - Fax:205-483-8144
Practice Address - Street 1:426 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:AL
Practice Address - Zip Code:35550-6000
Practice Address - Country:US
Practice Address - Phone:205-483-8140
Practice Address - Fax:205-483-8144
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO552207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALG67762Medicare UPIN