Healthcare Provider Details

I. General information

NPI: 1407143480
Provider Name (Legal Business Name): DAVID RYAN SKINNER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 ASSOCIATES BLVD
ALCOA TN
37701-1943
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 865-238-6400
  • Fax: 865-238-6404
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberDO0000002977
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberDO0000002977
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: