Affiliated Dermatology, PC
Organization Active NPI Procedural Dermatology Physician · Dothan, AL
NPI 1124008636 · NPPES record last updated Sep 11, 2025
Key facts
- NPI
- 1124008636
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Procedural Dermatology Physician 207NS0135X
- Legal business name
- AFFILIATED DERMATOLOGY, PC
- Practice address
- 4300 W Main St
Suite 102
Dothan, AL 36305-1054 - Phone
- (334) 793-9564
- Fax
- (334) 671-8907
- NPI assigned
- Jan 19, 2006
- Organization subpart
- No
Authorized official
- Name
- Mrs. Lois W Sallas
- Title
- Administrator
- Phone
- (334) 793-9564
Practitioners 11
-
Norma Faye McKnight, CRNP
-
Kelli Nicole Heer, PA-C
-
Tonia L Ruddock, MD
-
Laura M Tamburin, MD
-
Ankit Agarwal, M.D.
-
Danielle H Cady, DNP, ACNP-BC, APRN
-
John Shumway, MD
-
Saylor Ryals, CRNP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 01D0304727 | Affiliated Dermatology | Compliance | Apr 22, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040720000685 | AL | Part B Supplier - Clinic/Group Practice | 2163401332 |
Receives reassigned benefits from 11 practitioners Practice locations: Dothan, AL |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician |
207N00000X | |||
| MOHS-Micrographic Surgery Physician |
207ND0101X | |||
| Procedural Dermatology Physician |
207NS0135X | Yes |
Addresses
Primary practice location
4300 W Main St
Suite 102
Dothan, AL 36305-1054
Mailing address
4300 W Main St
Suite 102
Dothan, AL 36305-1054
Phone (334) 793-9564
Other providers in Dothan, AL
- Advanced Provider Solutions, LLC
- Advanced Urgent Centers LLC
- Damni Advani
- Advantage Dental Oral Health and Vision Center of Alabama, P.C.
- Advantage Dental Oral Health and Vision Center of Alabama, P.C.
- Affordable Dentures & Implants - Dothan II, P.C.
- Anika Ajaykumar Agarwal
- Ahmad Mostafa Abdelbaset Ahmad
- Mahmoud Ahmad
- Christopher Ahmed
All providers in Dothan, AL · Procedural Dermatology Physician in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 11, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.