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General NPI Number Information
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NPI Number | 1467680546
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY CONSULTANTS, PLLC
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Dates
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Enumeration Date | 06/26/2009
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Last Update Date | 06/26/2009
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Provider Practice Location Address
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Address Line | 768 AVERY BLVD N
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City | RIDGELAND
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State | MS
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Zip | 39157-5219
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Country | US
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Telephone | 601-956-5924
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3135
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City | RIDGELAND
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State | MS
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Zip | 39158-3135
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHEMENE QUINN
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Credential | MD
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Telephone | 601-956-5924
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 18070
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | A63958
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License Number State | CA
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