Healthcare Provider Details

I. General information

NPI: 1235531906
Provider Name (Legal Business Name): HIGHLANDS DERMATOLOGY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2014
Last Update Date: 09/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 HOSPITAL DR SUITE 302
HIGHLANDS NC
28741-7623
US

IV. Provider business mailing address

209 HOSPITAL DR SUITE 302
HIGHLANDS NC
28741-7623
US

V. Phone/Fax

Practice location:
  • Phone: 828-526-1232
  • Fax: 828-526-9988
Mailing address:
  • Phone: 828-526-1232
  • Fax: 828-526-9988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number203895
License Number StateNC

VIII. Authorized Official

Name: MR. KELLY JOSEPH TANDY
Title or Position: OFFICE MANAGER
Credential:
Phone: 828-526-1232