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General NPI Number Information
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NPI Number | 1518278902
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY CENTER OF HICKORY, PA
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Dates
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Enumeration Date | 06/30/2010
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Last Update Date | 07/05/2011
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Provider Practice Location Address
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Address Line | 245 11TH AVE NE
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City | HICKORY
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State | NC
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Zip | 28601-3885
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Country | US
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Telephone | 828-328-3500
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Fax | 828-328-8777
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Provider Business Mailing Address
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Address Line | 245 11TH AVE NE
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City | HICKORY
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State | NC
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Zip | 28601-3885
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Country | US
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Telephone | 828-328-3500
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Fax | 828-328-8777
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JERRY LEE PRUITT
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Credential | M.D.
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Telephone | 828-328-3500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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