NPIMap

Organization Active NPI

Affiliated Dermatology, PC

  • Procedural Dermatology Physician
  • Dothan, AL
National Provider Identifier
1124008636
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Procedural Dermatology PhysicianTaxonomy code 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
Last updated
Sep 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Mrs. Lois W Sallas
Title
Administrator
Phone
(334) 793-9564

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X
MOHS-Micrographic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ND0101X
Procedural Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207NS0135X Primary

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040720000685 AL Part B Supplier - Clinic/Group Practice 2163401332 Receives reassigned benefits from 11 practitioners
Practice locations: Dothan, AL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
01D0304727Affiliated Dermatology4300 West Main St, Suite 102, Dothan, AL 36305ComplianceApr 22, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

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": "1137628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1124008636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4300 W MAIN ST",
            "address_2": "SUITE 102",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363051054",
            "telephone_number": "334-793-9564",
            "fax_number": "334-671-8907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 W MAIN ST",
            "address_2": "SUITE 102",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363051054",
            "telephone_number": "334-793-9564",
            "fax_number": "334-671-8907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AFFILIATED DERMATOLOGY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-19",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "SALLAS",
        "authorized_official_first_name": "LOIS",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "334-793-9564",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dothan, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.