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SOUTHEASTERN DERMATOLOGY CENTERS NPI 1194789172


NPI Information

NPI: 1194789172
Provider Name: SOUTHEASTERN DERMATOLOGY CENTERS
Classification: Specialist - 174400000X
Entity Type: Organization
Address:
817 PRINCETON AVE SW
POB II, SUITE 302
BIRMINGHAM, AL
ZIP 35211
Phone: (205) 781-6995
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SOUTHEASTERN DERMATOLOGY CENTERS is a specialist in Birmingham, AL. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. SOUTHEASTERN DERMATOLOGY CENTERS NPI is 1194789172. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

817 PRINCETON AVE SW
POB II, SUITE 302
BIRMINGHAM, AL
ZIP 35211-333
Phone: (205) 781-6995
Fax: (205) 781-8783

The provider's authorized official is G. Scott Fenn .
The authorized official title is Chief Integration Officer and has the following contact phone number (205) 715-5415.

The enumeration date for this NPI number is 4/14/2006 and was last updated on 3/30/2009.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1174400000XSpecialistYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1I595MEDICARE ID-TYPE UNSPECIFIEDALABAMA
2529904550MEDICAIDALABAMA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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