Private Diagnostic Clinic, PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

PRIVATE DIAGNOSTIC CLINIC, PLLC

Doing business as

Virginia Lightner Family Dermatology

Practice address

82 Wheaton Ave
Youngsville, NC 27596-8691

Phone

(919) 562-8887

NPI assigned

Feb 27, 2013

Organization subpart

No

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

Authorized official

Name

Paul R Newman

Title

Executive Director, PDC

Phone

(919) 613-7652

Specialties & licenses 1

Addresses

Other names 1

• Virginia Lightner Family Dermatology Doing business as

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

{
    "created_epoch": "1361923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657497600000",
    "number": "1609116664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 110566",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277095566",
            "telephone_number": "919-620-4855",
            "fax_number": "919-620-4921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "82 WHEATON AVE",
            "city": "YOUNGSVILLE",
            "state": "NC",
            "postal_code": "275968691",
            "telephone_number": "919-562-8887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIVATE DIAGNOSTIC CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-27",
        "last_updated": "2022-07-11",
        "certification_date": "2022-07-11",
        "status": "A",
        "authorized_official_last_name": "NEWMAN",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR, PDC",
        "authorized_official_telephone_number": "919-613-7652"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Virginia Lightner Family Dermatology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Virginia Lightner Family Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Dan M Phillips, MD
• Tanya Donnella Pleasent
• Polaris Rehabilitation, LLC
• Powerful Purpose Psychological & Support Services PLLC
• Primus Home Health Solutions LLC
• Hannah Proctor, MA, CCC/SLP
• Jaclyn S Qualter, NP
• Queer Wave Counseling, PLLC
• Sherri Marie Raley, DC
• Anita Bellamy Raynor

• Dermatology Physician in Youngsville, NC
• Providers in Youngsville, 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 11, 2022; 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.