Seaside Dermatology PA

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

36498 Issued in SC

Legal business name

SEASIDE DERMATOLOGY PA

Practice address

4017 Highway 17
Suite 200
Murrells Inlet, SC 29576-5032

Phone

(843) 651-4600

Fax

(843) 651-4601

NPI assigned

Mar 13, 2014

Organization subpart

No

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

Authorized official

Name

Vienna L. Gibson, DONPI 1306171582

Title

Owner

Phone

(843) 651-4600

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Enrollment records 1

Locations

Practitioners 5

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

• Vienna L. Gibson, D.O.

  • Dermatology Physician
  • Murrells Inlet, SC
  • NPI 1306171582
  Medicare reassignment Care Compare group NPD Authorized official
• Brittany Stancil, NURSE PRACTITIONER

  • Nurse Practitioner
  • Murrells Inlet, SC
  • NPI 1811759038
  Medicare reassignment Care Compare group NPD
• Rachel Holley Paull, PA

  • Medical Physician Assistant
  • Murrells Inlet, SC
  • NPI 1689126617
  Medicare reassignment Care Compare group
• Analise Hughes, PA-C

  • Medical Physician Assistant
  • Norfolk, VA
  • NPI 1083068167

  SC

  Medicare reassignment
• Siera Makenzie Kirby, PA-C

  • Physician Assistant
  • Murrells Inlet, SC
  • NPI 1043143712
  NPD (past)

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

{
    "created_epoch": "1394668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583280000000",
    "number": "1376969428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 691",
            "city": "MURRELS INLET",
            "state": "SC",
            "postal_code": "29576",
            "telephone_number": "843-651-4600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4017 HIGHWAY 17",
            "address_2": "SUITE 200",
            "city": "MURRELLS INLET",
            "state": "SC",
            "postal_code": "295765032",
            "telephone_number": "843-651-4600",
            "fax_number": "843-651-4601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEASIDE DERMATOLOGY PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-13",
        "last_updated": "2020-03-04",
        "certification_date": "2020-03-04",
        "status": "A",
        "authorized_official_last_name": "GIBSON",
        "authorized_official_first_name": "VIENNA",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-651-4600",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "SC",
            "license": "36498",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steve W. Schwartz, M.D.
• Scoliosis Solutions
• Mary Caroline Seager, NP-C
• Kaleigh Elizabeth Seals, PA-C
• Seaside Anesthesia Consultants
• Seaside Eye Associates South LLC
• Seaside Oral & Maxillofacial Surgery Inc
• Seaside Pediatric Dental Associates
• Seaside Surgical, Inc.
• Don Edward Sessions Jr.

• Dermatology Physician in Murrells Inlet, SC
• Providers in Murrells Inlet, 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 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.