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DERMATOLOGY ASSOCIATES LLC NPI 1235318874


NPI Information

NPI: 1235318874
Provider Name: DERMATOLOGY ASSOCIATES LLC
Classification: Clinic/Center - 261QM2500X
Entity Type: Organization

Specialization: Medical Specialty

CLIA Number: 25D0993428

Address:
501 MARSHALL ST STE 606
JACKSON, MS
ZIP 39202
Phone: (601) 355-8555
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DERMATOLOGY ASSOCIATES LLC is a medical specialty clinic center in Jackson, MS. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). DERMATOLOGY ASSOCIATES LLC NPI is 1235318874. The provider is registered as an organization entity type.

The provider's business location address is:

501 MARSHALL ST STE 606
JACKSON, MS
ZIP 39202-650
Phone: (601) 355-8555
Fax: (601) 355-2244

The provider's authorized official is Sabra Sullivan .
The authorized official title is Manager/owner and has the following contact phone number (601) 355-8555.

The CLIA number assigned to this NPI record is 25D0993428 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 10/31/2007 and was last updated on 10/31/2007.


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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QM2500XClinic/CenterMedical SpecialtyYes

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 Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1CO2663MEDICARE PINMISSISSIPPI

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: 5/5/2024

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