Provider Demographics
NPI:1225855307
Name:EQUITY DERMATOLOGY, PLLC
Entity type:Organization
Organization Name:EQUITY DERMATOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:ALLRED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-428-4063
Mailing Address - Street 1:1802 ROCKINGHAM AVE
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-3348
Mailing Address - Country:US
Mailing Address - Phone:270-213-7777
Mailing Address - Fax:844-444-1250
Practice Address - Street 1:1802 ROCKINGHAM AVE
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3348
Practice Address - Country:US
Practice Address - Phone:270-213-7777
Practice Address - Fax:844-444-1250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-20
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty