NPIMap

Organization Active NPI

Brentwood Skin Clinic PLLC

  • Dermatology Physician
  • Nashville, TN
National Provider Identifier
1043647142
Registry record updated Nov 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
37546 Issued in TN
Legal business name
BRENTWOOD SKIN CLINIC PLLC
Practice address
5505 Edmondson Pike
Suite 10
Nashville, TN 37211-5872
Phone
(615) 810-8730
Fax
(615) 810-8731
NPI assigned
Oct 3, 2013
Last updated
Nov 21, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Charles Austin Mitchell III, MDNPI 1245238567
Title
President/Owner
Phone
(615) 810-8730

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 37546 TN Primary

Addresses

Primary practice location

5505 Edmondson Pike
Suite 10
Nashville, TN 37211-5872

Mailing address

5505 Edmondson Pike
Suite 10
Nashville, TN 37211-5872
Phone (615) 810-8730

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1380758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1511222400000",
    "number": "1043647142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5505 EDMONDSON PIKE",
            "address_2": "SUITE 10",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372115872",
            "telephone_number": "615-810-8730",
            "fax_number": "615-810-8731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5505 EDMONDSON PIKE",
            "address_2": "SUITE 10",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372115872",
            "telephone_number": "615-810-8730",
            "fax_number": "615-810-8731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRENTWOOD SKIN CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-03",
        "last_updated": "2017-11-21",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "AUSTIN",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "615-810-8730",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "TN",
            "license": "37546",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nashville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.