Healthcare Provider Details

I. General information

NPI: 1245167071
Provider Name (Legal Business Name): PINNACLE DERMATOLOGY, S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2685 JOLLY RD
OKEMOS MI
48864-3553
US

IV. Provider business mailing address

5141 VIRGINIA WAY STE 350
BRENTWOOD TN
37027-2319
US

V. Phone/Fax

Practice location:
  • Phone: 517-993-5900
  • Fax:
Mailing address:
  • Phone: 615-457-8143
  • Fax: 615-250-6723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: DANA CONNER
Title or Position: DIRECTOR SUPPLY CHAIN AND PHARMACY
Credential:
Phone: 615-457-8143