Provider Demographics
NPI:1215257241
Name:LOW COUNTRY DERMATOLOGY LLC
Entity type:Organization
Organization Name:LOW COUNTRY DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CORINNE
Authorized Official - Middle Name:MEEK
Authorized Official - Last Name:HOWINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-354-1018
Mailing Address - Street 1:6510 WATERS AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2714
Mailing Address - Country:US
Mailing Address - Phone:912-354-1018
Mailing Address - Fax:912-354-1019
Practice Address - Street 1:6510 WATERS AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2714
Practice Address - Country:US
Practice Address - Phone:912-354-1018
Practice Address - Fax:912-354-1019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-01
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055599207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH69853Medicare UPIN