Graham's Dermatology Services, PA

Primary specialty

SpecialistTaxonomy code 174400000X

License

38343 Issued in NC

Legal business name

GRAHAM'S DERMATOLOGY SERVICES, PA

Practice address

106 Cypress Dr
Pine Knoll Shores, NC 28512-6706

Phone

(252) 247-6621

Fax

(252) 247-6621

NPI assigned

Dec 16, 2005

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Robin Shackelford Griffin

Title

Insurance Representive

Phone

(252) 672-7729

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1134691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1275519761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 CYPRESS DR",
            "city": "PINE KNOLL SHORES",
            "state": "NC",
            "postal_code": "285126706",
            "telephone_number": "252-247-6621",
            "fax_number": "252-247-6621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 CYPRESS DR",
            "city": "PINE KNOLL SHORES",
            "state": "NC",
            "postal_code": "285126706",
            "telephone_number": "252-247-6621",
            "fax_number": "252-247-6621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAHAM'S DERMATOLOGY SERVICES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-16",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GRIFFIN",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_middle_name": "SHACKELFORD",
        "authorized_official_title_or_position": "INSURANCE REPRESENTIVE",
        "authorized_official_telephone_number": "252-672-7729"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NC",
            "license": "38343",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5900379",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Russell Meyers, LCAS-A
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• Town of Pine Knoll Shores

• Specialist in Pine Knoll Shores, NC
• Providers in Pine Knoll Shores, NC by specialty
• Specialist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.