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General NPI Number Information
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NPI Number | 1215940366
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Entity Type | Organization
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Legal Business Name | SKIN SOLUTIONS DERMATOLOGY & SKIN CANCER SURGERY, P.C.
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Dates
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Enumeration Date | 08/13/2006
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Last Update Date | 08/13/2007
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Provider Practice Location Address
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Address Line | 200 COOL SPRINGS BLVD
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City | FRANKLIN
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State | TN
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Zip | 37067-2677
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Country | US
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Telephone | 615-771-7546
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Fax | 615-771-8600
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Provider Business Mailing Address
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Address Line | 200 COOL SPRINGS BLVD
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City | FRANKLIN
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State | TN
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Zip | 37067-2677
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Country | US
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Telephone | 615-771-7546
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Fax | 615-771-8600
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | JULIE PENA
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Credential | M.D.
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Telephone | 615-771-7546
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD0000033935
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License Number State | TN
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