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General NPI Number Information
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NPI Number | 1710187059
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Entity Type | Organization
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Legal Business Name | SKIN CANCER AND SURGERY CENTER, PLC
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Dates
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Enumeration Date | 07/24/2007
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Last Update Date | 10/07/2007
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Provider Practice Location Address
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Address Line | 1900 PATTERSON ST SUITE 201
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City | NASHVILLE
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State | TN
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Zip | 37203-2119
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Country | US
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Telephone | 615-322-1221
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Fax | 615-322-5401
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Provider Business Mailing Address
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Address Line | 1900 PATTERSON ST SUITE 201
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City | NASHVILLE
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State | TN
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Zip | 37203-2119
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Country | US
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Telephone | 615-322-1221
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Fax | 615-322-5401
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Authorized Official
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Title or Position | DERMATOLOGIST
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Name | DR. BRENT R MOODY
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Credential | M. D.
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Telephone | 615-322-1221
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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 | 37502
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License Number State | TN
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