Southern Dermatology LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

11685 Issued in SC

Legal business name

SOUTHERN DERMATOLOGY LLC

Practice address

2110 Woodside Executive CT
Aiken, SC 29803-3809

Phone

(803) 644-5779

NPI assigned

Dec 16, 2011

Organization subpart

No

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

Authorized official

Name

Dr. John R Cook, M.D.

Title

Owner

Phone

(803) 644-5779

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1323993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323993600000",
    "number": "1821367046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2110 WOODSIDE EXECUTIVE CT",
            "city": "AIKEN",
            "state": "SC",
            "postal_code": "298033809",
            "telephone_number": "803-644-5779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2110 WOODSIDE EXECUTIVE CT",
            "city": "AIKEN",
            "state": "SC",
            "postal_code": "298033809",
            "telephone_number": "803-644-5779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-16",
        "last_updated": "2011-12-16",
        "status": "A",
        "authorized_official_last_name": "COOK",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "803-644-5779",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "SC",
            "license": "11685",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP2477",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in Aiken, SC
• Providers in Aiken, SC by specialty
• Dermatology Physician in South Carolina

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