Healthcare Provider Details

I. General information

NPI: 1689922668
Provider Name (Legal Business Name): SKIN DIAGNOSTICS GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2012
Last Update Date: 08/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3125 INDEPENDENCE DR SUITE 301
HOMEWOOD AL
35209-4159
US

IV. Provider business mailing address

3125 INDEPENDENCE DR SUITE 301
HOMEWOOD AL
35209-4159
US

V. Phone/Fax

Practice location:
  • Phone: 205-879-2260
  • Fax: 205-879-2261
Mailing address:
  • Phone: 205-879-2260
  • Fax: 205-879-2261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number25042
License Number StateAL

VIII. Authorized Official

Name: DR. JAMES ALAN LONG
Title or Position: PRESIDENT
Credential: MD
Phone: 205-879-2260