Healthcare Provider Details

I. General information

NPI: 1003009390
Provider Name (Legal Business Name): DERMATOPATHOLOGY SPECIALISTS JIM PHILLIPS MD DERMATOPATHOLOGIST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 03/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 JOHNNIE DODDS BLVD SUITE 101
MT PLEASANT SC
29464-3287
US

IV. Provider business mailing address

PO BOX 30309
CHARLESTON SC
29417-0309
US

V. Phone/Fax

Practice location:
  • Phone: 843-375-0055
  • Fax:
Mailing address:
  • Phone: 843-554-9300
  • Fax: 843-566-8780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number8871
License Number StateSC

VIII. Authorized Official

Name: DR. JAMES H. PHILLIPS
Title or Position: OWNER
Credential: MD
Phone: 843-375-0055