Dermatology Center of Hickory, PA

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

DERMATOLOGY CENTER OF HICKORY, PA

Practice address

245 11TH Ave NE
Hickory, NC 28601-3885

Phone

(828) 328-3500

Fax

(828) 328-8777

NPI assigned

Jun 30, 2010

Last updated

Jul 5, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jerry Lee Pruitt, M.D.NPI 1124078274

Title

President

Phone

(828) 328-3500

Specialties & licenses 1

Addresses

Other identifiers 2

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.

• Jerry L Pruitt, M.D.

  • Dermatology Physician
  • Hickory, NC
  • NPI 1124078274
  Authorized official Same address or phone

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

{
    "created_epoch": "1277856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309824000000",
    "number": "1518278902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 11TH AVE NE",
            "city": "HICKORY",
            "state": "NC",
            "postal_code": "286013885",
            "telephone_number": "828-328-3500",
            "fax_number": "828-328-8777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 11TH AVE NE",
            "city": "HICKORY",
            "state": "NC",
            "postal_code": "286013885",
            "telephone_number": "828-328-3500",
            "fax_number": "828-328-8777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY CENTER OF HICKORY, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-30",
        "last_updated": "2011-07-05",
        "status": "A",
        "authorized_official_last_name": "PRUITT",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "828-328-3500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF NORTH CAROLINA",
            "identifier": "69390",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "070015170",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Barbara J Denison, CRNA
• Caleb Andrew Depp, CRNA
• Sidney Miller Deramus, LCAS-A
• Sarah Dergins, LCSW
• John Joseph Derienzis, PT
• Desantis Family Practice
• Michael Christopher Desantis, M.D.
• Holly Capitano Desena, MD
• Susan E Desroches, FNP-C
• Destiny Management Incorporated

• Dermatology Physician in Hickory, NC
• Providers in Hickory, NC by specialty
• Dermatology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2011; 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.