Tullahoma Dermatology PC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

TULLAHOMA DERMATOLOGY PC

Practice address

1330 Cedar LN Ste 700
Tullahoma, TN 37388-3276

Phone

(931) 455-7400

NPI assigned

Jun 30, 2020

Organization subpart

No

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

Authorized official

Name

Isaac BryanNPI 1558708701

Title

President

Phone

(509) 426-4985

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

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

CLIA laboratory certificates

Practitioners 2

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

• Isaac Gene Bryan, D.O.

  • Dermatology Physician
  • Tullahoma, TN
  • NPI 1558708701
  Medicare reassignment Care Compare group NPD Authorized official
• Rebecca Sams Layton, PA-C

  • Physician Assistant
  • Oak Ridge, TN
  • NPI 1386979573
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1593475200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593475200000",
    "number": "1154948669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1330 CEDAR LN STE 700",
            "city": "TULLAHOMA",
            "state": "TN",
            "postal_code": "373883276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1330 CEDAR LN STE 700",
            "city": "TULLAHOMA",
            "state": "TN",
            "postal_code": "373883276",
            "telephone_number": "931-455-7400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TULLAHOMA DERMATOLOGY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-30",
        "last_updated": "2020-06-30",
        "certification_date": "2020-06-30",
        "status": "A",
        "authorized_official_last_name": "BRYAN",
        "authorized_official_first_name": "ISAAC",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "509-426-4985"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca Tucker, SLP-CCC
• Tullahoma Advanced Care Inc.
• Tullahoma Chiropractic and Medical Center
• Tullahoma City Schools
• Tullahoma Dental Group, PLLC
• Tullahoma Drug Store Inc
• Tullahoma Family Dentistry PLLC
• Tullahoma Hma LLC
• Tullahoma Hma LLC
• Tullahoma Hma Physician Management, LLC

• Dermatology Physician in Tullahoma, TN
• Providers in Tullahoma, TN by specialty
• Dermatology Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2020; 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.