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NPI Code Detail

MEDICARE: GRAND STRAND DERMATOLOGY

MEDICARE: GRAND STRAND DERMATOLOGY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology Physician17893SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1033160213
Entity Type Code : Organization
Provider Name (Legal Business Name) : GRAND STRAND DERMATOLOGY
Provider Business Mailing Address
First Line : 7410 HIGHWAY 707
Second Line :
City : MYRTLE BEACH
State : SC
Zip : 29588-7304
Country : US
Telephone Number : 843-215-1100
Fax Number : 843-215-1211
Provider Business Practice Location Address
First Line : 7410 HIGHWAY 707
Second Line :
City : MYRTLE BEACH
State : SC
Zip : 29588-7304
Country : US
Telephone Number : 843-215-1100
Fax Number : 843-215-1211
Authorized Official
Title or Position : MANAGING PARTNER
Name : NATHAN PATRICK JONES
Credential :
Telephone Number : 843-215-1100
Provider Enumeration Date : 05/13/2006
Last Update Date : 10/30/2025

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Practice Location Address:
7410 HIGHWAY 707
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Practice Fax:
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MYRTLE BEACH, SC
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29588-7304
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MYRTLE BEACH, SC
29588-7304
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1689439473 — KAHEALANI LANE
Practice Location Address:
7410 HIGHWAY 707
MYRTLE BEACH, SC
29588-7304
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Practice Fax:

Directions to “GRAND STRAND DERMATOLOGY ” Practice Location

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