Healthcare Provider Details

I. General information

NPI: 1346026028
Provider Name (Legal Business Name): SKINSCIENCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 BAYTREE RD STE D
VALDOSTA GA
31602-2881
US

IV. Provider business mailing address

4223 OAK FOREST DR
VALDOSTA GA
31602-0853
US

V. Phone/Fax

Practice location:
  • Phone: 229-560-2885
  • Fax:
Mailing address:
  • Phone: 229-560-2885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. WINDY DAWN GIDDENS
Title or Position: OWNER
Credential: NP-C
Phone: 229-560-2885