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General NPI Number Information
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NPI Number | 1972761377
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Entity Type | Organization
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Legal Business Name | ALABAMA SKIN INSTITUTE, INC
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Dates
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Enumeration Date | 06/02/2008
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Last Update Date | 06/02/2008
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Provider Practice Location Address
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Address Line | 6285 PARK SOUTH DR
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City | BESSEMER
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State | AL
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Zip | 35022-5670
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Country | US
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Telephone | 205-426-5507
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Fax | 205-426-5563
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Provider Business Mailing Address
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Address Line | 6285 PARK SOUTH DR
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City | BESSEMER
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State | AL
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Zip | 35022-5670
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Country | US
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Telephone | 205-426-5507
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Fax | 205-426-5563
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. JASON L LOCKRIDGE
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Credential | M.D.
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Telephone | 205-426-5507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 22467
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License Number State | AL
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