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General NPI Number Information
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NPI Number | 1295324366
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Entity Type | Organization
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Legal Business Name | ADULT & PEDIATRIC DERMATOLOGY SKIN SOLUTIONS PLLC
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Dates
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Enumeration Date | 01/13/2021
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Last Update Date | 06/01/2022
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Provider Practice Location Address
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Address Line | 151 LEDFORD MILL RD
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City | TULLAHOMA
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State | TN
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Zip | 37388-2278
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Country | US
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Telephone | 931-800-6400
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Fax | 931-800-6401
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Provider Business Mailing Address
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Address Line | PO BOX 802
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City | TULLAHOMA
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State | TN
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Zip | 37388-0802
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Country | US
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Telephone | 931-800-6400
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Fax | 931-800-6401
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LORIE M BURTTS
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Credential |
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Telephone | 931-800-6400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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