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General NPI Number Information
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NPI Number | 1942637772
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Entity Type | Organization
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Legal Business Name | PREMIER DERMATOLOGY AND SKIN CANCER CENTER, PLLC
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Dates
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Enumeration Date | 10/13/2013
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Last Update Date | 10/23/2013
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Provider Practice Location Address
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Address Line | 5935 WASHINGTON AVE SUITE A
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564-2642
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Country | US
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Telephone | 228-215-0669
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Fax | 228-215-0669
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Provider Business Mailing Address
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Address Line | 5935 WASHINGTON AVE SUITE A
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City | OCEAN SPRINGS
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State | MS
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Zip | 39564-2642
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Country | US
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Telephone | 228-215-0669
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Fax | 228-215-0669
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | MICHELE HUGHES
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Credential | M.D.
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Telephone | 228-215-0669
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 21095
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 21095
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License Number State | MS
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