NPIMap

Organization Active NPI

Summit Dermatology & Laser Center, P.C.

  • Dermatology Physician
  • Brunswick, GA
National Provider Identifier
1508920992
Registry record updated Apr 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
055102 Issued in GA
Legal business name
SUMMIT DERMATOLOGY & LASER CENTER, P.C.
Practice address
1111 Glynco Pkwy
BLDG 1, Suite 20
Brunswick, GA 31525-7921
Phone
(912) 262-1801
Fax
(912) 264-6262
NPI assigned
Dec 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2008

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

Authorized official

Name
Dr. Lawrence George Blasik Jr., M.D.
Title
Owner
Phone
(912) 262-1801

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 055102 GA Primary

Addresses

Primary practice location

1111 Glynco Pkwy
BLDG 1, Suite 20
Brunswick, GA 31525-7921

Mailing address

1111 Glynco Pkwy
BLDG 1, Suite 20
Brunswick, GA 31525-7921
Phone (912) 262-1801

Other identifiers 1

IdentifierTypeStateIssuer
DB9882OtherGARR MEDICARE

National Provider Directory

National Provider Directory

Locations

1111 Glynco Pkwy
Ste 20
Brunswick, GA 31525
Phone (912) 262-1801

Practitioners & affiliated clinicians

Practitioners 7

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

NPI Registry JSON

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

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208304000000",
    "number": "1508920992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 GLYNCO PKWY",
            "address_2": "BLDG 1, SUITE 20",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315257921",
            "telephone_number": "912-262-1801",
            "fax_number": "912-264-6262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 GLYNCO PKWY",
            "address_2": "BLDG 1, SUITE 20",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "315257921",
            "telephone_number": "912-262-1801",
            "fax_number": "912-264-6262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT DERMATOLOGY & LASER CENTER, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-20",
        "last_updated": "2008-04-16",
        "status": "A",
        "authorized_official_last_name": "BLASIK",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_middle_name": "GEORGE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "912-262-1801",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "GA",
            "license": "055102",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DB9882",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brunswick, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2008; 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.