| NPI | 1295824415 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA SUE STUFFLESTREET Practice Administrator 423-722-0565 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery |
| 207ND0900X Dermatology Dermatopathology | |
| 207NS0135X Dermatology Procedural Dermatology | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2018-03-17 |