Northeast Dermatology, PA

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

22975 Issued in SC

Legal business name

NORTHEAST DERMATOLOGY, PA

Practice address

220 Graces Way
Columbia, SC 29229

Phone

(803) 736-4560

Fax

(803) 744-1217

NPI assigned

Sep 26, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Lee Smith Carson, M.D.

Title

President

Phone

(803) 736-4560

Specialties & licenses 1

Addresses

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Abigail Sloan Ham, PA-C

  • Physician Assistant
  • Florence, SC
  • NPI 1528494051
  NPD
• James Petit, MD

  • Dermatology Physician
  • Augusta, GA
  • NPI 1720516560
  NPD
• Victoria Rosa

  • Physician Assistant
  • Florence, SC
  • NPI 1558906792
  NPD (past)
• Carrie Powers Zipperer, PA

  • Physician Assistant
  • Columbia, SC
  • NPI 1477784833
  NPD (past)

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1154422558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 GRACES WAY",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29229",
            "telephone_number": "803-736-4560",
            "fax_number": "803-744-1217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 GRACES WAY",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "29229",
            "telephone_number": "803-736-4560",
            "fax_number": "803-744-1217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST DERMATOLOGY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-26",
        "last_updated": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "CARSON",
        "authorized_official_first_name": "LEE",
        "authorized_official_middle_name": "SMITH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "803-736-4560",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "SC",
            "license": "22975",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Northeast Columbia Psychotherapy Practice Inc.
• Northeast Elite Medical Clinic, LLC
• Northeast Family Dentistry
• Northeast Medical Specialists
• Northeast Oral & Maxillofacial
• Northeast Oral & Maxillofacial Surgery Center

• Dermatology Physician in Columbia, SC
• Providers in Columbia, 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 Mar 7, 2023; 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.