Healthcare Provider Details

I. General information

NPI: 1770782849
Provider Name (Legal Business Name): DECATUR DERMATOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 08/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 WALNUT STREET NE SUITE A
DECATUR AL
35601-2456
US

IV. Provider business mailing address

620 WALNUT STREET NE SUITE A
DECATUR AL
35601-2456
US

V. Phone/Fax

Practice location:
  • Phone: 256-353-7775
  • Fax: 256-353-7765
Mailing address:
  • Phone: 256-353-7775
  • Fax: 256-353-7765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA WYATT
Title or Position: PHYSICIAN/PRESIDENT
Credential: MD
Phone: 256-353-7775