Healthcare Provider Details

I. General information

NPI: 1578488417
Provider Name (Legal Business Name): HORIZON DERMATOLOGY AND SKIN SURGERY CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1523 25TH ST NW
CLEVELAND TN
37311
US

IV. Provider business mailing address

1523 25TH ST NW
CLEVELAND TN
37311
US

V. Phone/Fax

Practice location:
  • Phone: 423-398-4097
  • Fax: 423-769-0218
Mailing address:
  • Phone: 423-398-4097
  • Fax: 423-769-0218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: LUKE MAXFIELD
Title or Position: OWNER
Credential:
Phone: 719-201-3373