NPIMap

Organization Active NPI

Lakeway Dermatology Associates, PC

  • Dermatology Physician
  • Morristown, TN
National Provider Identifier
1114123056
Registry record updated Feb 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
LAKEWAY DERMATOLOGY ASSOCIATES, PC
Practice address
400 E Economy Rd
Suite 8
Morristown, TN 37814-3388
Phone
(423) 587-4600
Fax
(423) 581-1729
NPI assigned
Jun 26, 2007
Last updated
Feb 26, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2024

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

Authorized official

Name
Conrad L Brimhall, MDNPI 1598740532
Title
VP
Phone
(859) 276-1511

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X Primary

Addresses

Primary practice location

400 E Economy Rd
Suite 8
Morristown, TN 37814-3388

Mailing address

400 E Economy Rd
Suite 8
Morristown, TN 37814-3388
Phone (423) 587-4600

National Provider Directory

National Provider Directory

Locations

1709 W Andrew Johnson Hwy
Morristown, TN 37814
Phone (423) 587-4600

400 E Economy Rd
Ste 8
Morristown, TN 37814
Phone (423) 587-4600

Practitioners & affiliated clinicians

Practitioners 8

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": "1182816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708905600000",
    "number": "1114123056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 E ECONOMY RD",
            "address_2": "SUITE 8",
            "city": "MORRISTOWN",
            "state": "TN",
            "postal_code": "378143388",
            "telephone_number": "423-587-4600",
            "fax_number": "423-558-0010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 E ECONOMY RD",
            "address_2": "SUITE 8",
            "city": "MORRISTOWN",
            "state": "TN",
            "postal_code": "378143388",
            "telephone_number": "423-587-4600",
            "fax_number": "423-581-1729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEWAY DERMATOLOGY ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-26",
        "last_updated": "2024-02-26",
        "certification_date": "2024-02-26",
        "status": "A",
        "authorized_official_last_name": "BRIMHALL",
        "authorized_official_first_name": "CONRAD",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "859-276-1511",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Morristown, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2024; 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.