Provider Demographics
NPI:1063715423
Name:SKIN CANCER AND COSMETIC DERMATOLOGY CENTER PC
Entity type:Organization
Organization Name:SKIN CANCER AND COSMETIC DERMATOLOGY CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:FINNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-277-7311
Mailing Address - Street 1:1107 MEMORIAL DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-8668
Mailing Address - Country:US
Mailing Address - Phone:706-277-7311
Mailing Address - Fax:706-272-3512
Practice Address - Street 1:400 DIXIE LEE CENTER RD
Practice Address - Street 2:SUITE C
Practice Address - City:KIMBALL
Practice Address - State:TN
Practice Address - Zip Code:37347-5672
Practice Address - Country:US
Practice Address - Phone:706-277-7311
Practice Address - Fax:706-272-3512
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SKIN CANCER AND COSMETIC DERMATOLOGY CENTER PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-07
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty