Provider Demographics
NPI:1962701052
Name:DERMATOLOGY SPECIALISTS OF CHARLOTTE PA
Entity type:Organization
Organization Name:DERMATOLOGY SPECIALISTS OF CHARLOTTE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:G
Authorized Official - Last Name:NIXON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-341-0090
Mailing Address - Street 1:8936 BLAKENEY PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-6660
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8936 BLAKENEY PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-6660
Practice Address - Country:US
Practice Address - Phone:704-341-0090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-15
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800340174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty