NPIMap

Organization Active NPI

Skin Cancer and Cosmetic Dermatology Center PC

  • Dermatology Physician
  • Kimball, TN
National Provider Identifier
1063715423
Registry record updated Jan 17, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
SKIN CANCER AND COSMETIC DERMATOLOGY CENTER PC
Practice address
400 Dixie Lee Center Rd
Suite C
Kimball, TN 37347-5672
Phone
(706) 277-7311
Fax
(706) 272-3512
NPI assigned
Dec 7, 2010
Last updated
Jan 17, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
SKIN CANCER AND COSMETIC DERMATOLOGY CENTER PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 17, 2011

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

Authorized official

Name
Kelley Finnell
Title
Practice Manager
Phone
(706) 277-7311

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU Primary

Addresses

Primary practice location

400 Dixie Lee Center Rd
Suite C
Kimball, TN 37347-5672

Mailing address

1107 Memorial Dr
Suite 201
Dalton, GA 30720-8668
Phone (706) 277-7311

National Provider Directory

National Provider Directory
Part of
Skin Cancer and Cosmetic

Locations

400 Dixie Lee Center Rd
Ste C
Kimball, TN 37347
Phone (423) 702-6899

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 6

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": "1291680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1295222400000",
    "number": "1063715423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1107 MEMORIAL DR",
            "address_2": "SUITE 201",
            "city": "DALTON",
            "state": "GA",
            "postal_code": "307208668",
            "telephone_number": "706-277-7311",
            "fax_number": "706-272-3512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 DIXIE LEE CENTER RD",
            "address_2": "SUITE C",
            "city": "KIMBALL",
            "state": "TN",
            "postal_code": "373475672",
            "telephone_number": "706-277-7311",
            "fax_number": "706-272-3512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SKIN CANCER AND COSMETIC DERMATOLOGY CENTER PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SKIN CANCER AND COSMETIC DERMATOLOGY CENTER PC",
        "enumeration_date": "2010-12-07",
        "last_updated": "2011-01-17",
        "status": "A",
        "authorized_official_last_name": "FINNELL",
        "authorized_official_first_name": "KELLEY",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "706-277-7311"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kimball, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2011; 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.