Provider Demographics
NPI:1487695862
Name:DERMATOLOGY ASSOCIATES, P.C.
Entity type:Organization
Organization Name:DERMATOLOGY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INS & BILLING LEAD
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:BOLLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-246-4961
Mailing Address - Street 1:2300 W STONE DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-2360
Mailing Address - Country:US
Mailing Address - Phone:423-246-4961
Mailing Address - Fax:423-245-3136
Practice Address - Street 1:2300 W STONE DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-2360
Practice Address - Country:US
Practice Address - Phone:423-246-4961
Practice Address - Fax:423-245-3136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3380668Medicare PIN