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NPI Code Detail

MEDICARE: SKIN DIAGNOSTICS GROUP PC

MEDICARE: SKIN DIAGNOSTICS GROUP PC
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
1207ZD0900XDermatopathology (Pathology) Physician25042AL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
125042OTHERALMEDICAL LICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417280538
Entity Type Code : Organization
Provider Name (Legal Business Name) : SKIN DIAGNOSTICS GROUP PC
Provider Business Mailing Address
First Line : 3512 OLD MONTGOMERY HWY
Second Line :
City : BIRMINGHAM
State : AL
Zip : 35209-5706
Country : US
Telephone Number : 205-879-2260
Fax Number : 205-879-2261
Provider Business Practice Location Address
First Line : 3512 OLD MONTGOMERY HWY
Second Line :
City : BIRMINGHAM
State : AL
Zip : 35209-5706
Country : US
Telephone Number : 205-879-2260
Fax Number : 205-879-2261
Authorized Official
Title or Position : PRESIDENT
Name : DR. JAMES ALAN LONG
Credential : MD
Telephone Number : 205-879-2260
Provider Enumeration Date : 09/08/2009
Last Update Date : 07/27/2015

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Directions to “SKIN DIAGNOSTICS GROUP PC ” Practice Location

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