The Cutaneous Laser Center

Primary specialty

Procedural Dermatology PhysicianTaxonomy code 207NS0135X

License

14238 Issued in MT

Legal business name

THE CUTANEOUS LASER CENTER

Practice address

501 Marshall St Ste 606
Jackson, MS 39202-1650

Phone

(601) 355-8555

Fax

(601) 355-2244

NPI assigned

Oct 18, 2007

Organization subpart

No

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

Authorized official

Name

Sabra Sullivan, M.D.PHDNPI 1932176641

Title

Manager

Phone

(601) 355-8555

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.

• Sabra Sullivan, M.D., PHD.

  • Procedural Dermatology Physician
  • Madison, MS
  • NPI 1932176641
  NPD (past) Authorized official

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

{
    "created_epoch": "1192665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192665600000",
    "number": "1487843199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 MARSHALL ST STE 606",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392021650",
            "telephone_number": "601-355-8555",
            "fax_number": "601-355-2244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 MARSHALL ST STE 606",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392021650",
            "telephone_number": "601-355-8555",
            "fax_number": "601-355-2244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE CUTANEOUS LASER CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-18",
        "last_updated": "2007-10-18",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "SABRA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "601-355-8555",
        "authorized_official_credential": "M.D.PHD"
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "MT",
            "license": "14238",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert Marshall Tharp Jr., O.D.
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• The Joint Injection Clinic LLC
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• The Kristian Jacob Autism Center
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• The Pain Clinic of Mississippi, PLLC

• Procedural Dermatology Physician in Jackson, MS
• Providers in Jackson, MS by specialty
• Procedural Dermatology Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2007; 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.