Provider Demographics
NPI:1730567504
Name:DERMATOLOGY ASSOCIATES OF TALLAHASSEE, PA
Entity type:Organization
Organization Name:DERMATOLOGY ASSOCIATES OF TALLAHASSEE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-877-4134
Mailing Address - Street 1:PO BOX 13834
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-3834
Mailing Address - Country:US
Mailing Address - Phone:850-205-6232
Mailing Address - Fax:850-402-9130
Practice Address - Street 1:4233 CAMELOT XING
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-6926
Practice Address - Country:US
Practice Address - Phone:229-469-4383
Practice Address - Fax:229-469-4584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty