| NPI | 1174190003 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA COLLINS Physician Owner 606-694-2836 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207ND0101X Dermatology, MOHS-Micrographic Surgery |
| 207NS0135X Dermatology, Procedural Dermatology | |
| Enumeration Date | 2021-06-09 |
| Last Update Date | 2022-03-07 |