Healthcare Provider Details

I. General information

NPI: 1144419458
Provider Name (Legal Business Name): SKIN CANCER AND COSMETIC DERMATOLOGY CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2007
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2358 LIFESTYLE WAY STE 212
CHATTANOOGA TN
37421-4904
US

IV. Provider business mailing address

136 BATTLEFIELD CROSSING CT
RINGGOLD GA
30736-5176
US

V. Phone/Fax

Practice location:
  • Phone: 423-521-1100
  • Fax: 423-521-1200
Mailing address:
  • Phone: 706-277-7311
  • Fax: 706-529-7210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN CHUNG
Title or Position: OWNER
Credential: MD
Phone: 706-277-7311