MEDICARE: DERMATOLOGY AND SKIN SURGERY INC

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
1	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1366075343
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DERMATOLOGY AND SKIN SURGERY INC

Provider Business Mailing Address
First Line	:	560 CONSTITUTION DR
Second Line	:
City	:	SUMTER
State	:	SC
Zip	:	29154-8175
Country	:	US
Telephone Number	:	803-775-4469
Fax Number	:	803-775-4981

Provider Business Practice Location Address
First Line	:	560 CONSTITUTION DR
Second Line	:
City	:	SUMTER
State	:	SC
Zip	:	29154-8175
Country	:	US
Telephone Number	:	803-775-4469
Fax Number	:	803-775-4981

Authorized Official
Title or Position	:	SHAREHOLDER /CO-OWNER
Name	:	MR. PHILLIP L LATHAM JR.
Credential	:	MD
Telephone Number	:	803-775-4469

Provider Enumeration Date	:	02/18/2020
Last Update Date	:	09/29/2025

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