Healthcare Provider Details

I. General information

NPI: 1154344547
Provider Name (Legal Business Name): SOUTH CAROLINA SKIN CANCER CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 ASHBY PARK LANE
GREENVILLE SC
29607-6903
US

IV. Provider business mailing address

300 ASHBY PARK LANE
GREENVILLE SC
29607-6903
US

V. Phone/Fax

Practice location:
  • Phone: 864-288-1154
  • Fax: 864-288-2554
Mailing address:
  • Phone: 864-288-1154
  • Fax: 864-288-2554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberTL28759
License Number StateSC

VIII. Authorized Official

Name: DR. JAMES R DEBLOOM II
Title or Position: OWNER/PHYSICIAN
Credential: M.D.
Phone: 864-288-1154