Provider Demographics
NPI:1730596685
Name:ATLANTIC DERMATOLOGY
Entity type:Organization
Organization Name:ATLANTIC DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:WARRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-399-9965
Mailing Address - Street 1:2237 HIGHWAY 9 E
Mailing Address - Street 2:
Mailing Address - City:LONGS
Mailing Address - State:SC
Mailing Address - Zip Code:29568-5701
Mailing Address - Country:US
Mailing Address - Phone:843-399-9965
Mailing Address - Fax:843-399-9974
Practice Address - Street 1:2237 HIGHWAY 9 E
Practice Address - Street 2:
Practice Address - City:LONGS
Practice Address - State:SC
Practice Address - Zip Code:29568-5701
Practice Address - Country:US
Practice Address - Phone:843-399-9965
Practice Address - Fax:843-399-9974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-11
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty