Lakeway Dermatology Associates PC
Organization Active NPI Dermatology Physician · Morristown, TN
NPI 1386031979 · NPPES record last updated Feb 26, 2024
Key facts
- NPI
- 1386031979
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dermatology Physician 207N00000X
- Legal business name
- LAKEWAY DERMATOLOGY ASSOCIATES PC
- Practice address
- 400 E Economy Rd
Suite 8
Morristown, TN 37814-3388 - Phone
- (423) 587-4600
- Fax
- (423) 587-1729
- NPI assigned
- Apr 21, 2015
- Organization subpart
- No
Authorized official
- Name
- Conrad L Brimhall, MD
- Title
- VP
- Phone
- (859) 276-1511
Practitioners 9
-
Ann E Ayres, PA-C
-
Vita Lam Mayes, PA
-
Kristin Renae Hickman, APRN
-
Paul C. Maben, P.A.
-
Amy Browning Maurer, PA-C
-
Jeffery O Armstrong, PA C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150424000748 | TN | Part B Supplier - Clinic/Group Practice | 3678892684 |
Receives reassigned benefits from 5 practitioners Practice locations: Morristown, TN; Jefferson City, TN |
National Provider Directory
Locations
112 W Broadway Blvd
Jefferson City, TN 37760
Phone (865) 262-8240
400 E Economy Rd
Ste 8
Morristown, TN 37814
Phone (423) 581-1533
400 E Economy Rd
Morristown, TN 37814
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician |
207N00000X | Yes |
Addresses
Primary practice location
400 E Economy Rd
Suite 8
Morristown, TN 37814-3388
Mailing address
400 E Economy Rd
Suite 8
Morristown, TN 37814-3388
Phone (423) 587-4600
Other providers in Morristown, TN
- Hannah Christine Lafferty
- Kimberly Lafferty
- Colleen Michelle Clark Laing
- Lakeway Achievement Center
- Lakeway Ambulance Service
- Lakeway Dermatology Associates, PC
- Lakeway Emergency Physicians, LLC
- Lakeway Regional Anesthesia Services
- Heather Renae-Cobb Laliberte
- Adrionna Lillie Lamaster
All providers in Morristown, TN · Dermatology Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 26, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.