NPI | 1124008636 |
---|---|
Entity Type | Organization |
Authorized Contact | LOIS W SALLAS Administrator 334-793-9564 |
Organization Subpart ? | No |
Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology |
Additional Taxonomies | 207N00000X Dermatology |
207ND0101X Dermatology, MOHS-Micrographic Surgery | |
Enumeration Date | 2006-01-19 |
Last Update Date | 2025-09-11 |