Coosa River Dermatology, Inc

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

Legal business name

COOSA RIVER DERMATOLOGY, INC

Practice address

1242 Martin St S Ste B
Pell City, AL 35128-2310

Phone

(205) 514-1664

NPI assigned

Apr 9, 2024

Organization subpart

No

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

Authorized official

Name

Kelsey Real Kennedy, MDNPI 1194222844

Title

President/Ceo

Phone

(205) 514-1664

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kelsey Real Kennedy

  • Dermatology Physician
  • Birmingham, AL
  • NPI 1194222844

  Mohs-Micrographic Surgery

  NPD Authorized official

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

{
    "created_epoch": "1712620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712620800000",
    "number": "1447003579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 932",
            "city": "TRUSSVILLE",
            "state": "AL",
            "postal_code": "351730932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1242 MARTIN ST S STE B",
            "city": "PELL CITY",
            "state": "AL",
            "postal_code": "351282310",
            "telephone_number": "205-514-1664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COOSA RIVER DERMATOLOGY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-09",
        "last_updated": "2024-04-09",
        "certification_date": "2024-04-09",
        "status": "A",
        "authorized_official_last_name": "KENNEDY",
        "authorized_official_first_name": "KELSEY",
        "authorized_official_middle_name": "REAL",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "205-514-1664",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Clinical Urology Associates, P.C.
• Kimberli Clinkscales, CRNP
• Douglas Edwin Cole, PT
• Barry G Collins, MD
• Comfort Care Hospice, LLC (Aveanna Hospice of Pell City)
• Coosa Valley Equine Center, P. C.
• Cornerstone Chiropractic Inc.
• Christopher W Cox, CRNA
• Evelyn Grace Cox, OTR/L
• Kimberly Ann Crosier, R.PH

• MOHS-Micrographic Surgery Physician in Pell City, AL
• Providers in Pell City, AL by specialty
• MOHS-Micrographic Surgery Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2024; 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.