Fort Mill Dermatology, LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

15514 Issued in SC

Legal business name

FORT MILL DERMATOLOGY, LLC

Practice address

1700 First Baxter Xing
Ste 101
Fort Mill, SC 29708-8919

Phone

(803) 802-3376

Fax

(803) 802-3329

NPI assigned

Jul 25, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Rebecca Lynn Smith, MD

Title

President

Phone

(803) 802-3376

Specialties & licenses 3

Addresses

Locations

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193616000000",
    "number": "1053334045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 FIRST BAXTER XING",
            "address_2": "STE 101",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297088919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 FIRST BAXTER XING",
            "address_2": "STE 101",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297088919",
            "telephone_number": "803-802-3376",
            "fax_number": "803-802-3329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT MILL DERMATOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-25",
        "last_updated": "2007-10-29",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "803-802-3376",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "SC",
            "license": "15514",
            "primary": true
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": "SC",
            "license": "29310",
            "primary": false
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": "SC",
            "license": "15514",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alex Richard Ford, BOCCPO
• Terrance Ford, RBT
• Tuchana Ford
• Mallary Campbell Forrest, D.D.S.
• Fort Mill Chiropractic Health Center, P.a.
• Fort Mill Dobys Bridge Dental LLC
• Fort Mill Home Care
• Fort Mill Neurology, LLC
• Fort Mill Optical Inc
• Fort Mill Pharmacy

• Dermatology Physician in Fort Mill, SC
• Providers in Fort Mill, SC by specialty
• Dermatology Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2007; 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.