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General NPI Number Information
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NPI Number | 1730596685
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Entity Type | Organization
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Legal Business Name | ATLANTIC DERMATOLOGY
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Dates
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Enumeration Date | 07/11/2014
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Last Update Date | 08/18/2022
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Provider Practice Location Address
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Address Line | 2237 HIGHWAY 9 E
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City | LONGS
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State | SC
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Zip | 29568-5701
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Country | US
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Telephone | 843-399-9965
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Fax | 843-399-9974
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Provider Business Mailing Address
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Address Line | 2237 HIGHWAY 9 E
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City | LONGS
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State | SC
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Zip | 29568-5701
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Country | US
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Telephone | 843-399-9965
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Fax | 843-399-9974
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Authorized Official
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Title or Position | OWNER
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Name | DR. KENNETH RAY WARRICK
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Credential | M.D.
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Telephone | 843-399-9965
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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 | SC
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Taxonomy #2
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number |
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License Number State | SC
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