NPIMap

Organization Active NPI

Dermatology Associates of Montgomery, LLC

  • Specialist
  • Montgomery, AL
National Provider Identifier
1891064937
Registry record updated Dec 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
10825 Issued in AL
Legal business name
DERMATOLOGY ASSOCIATES OF MONTGOMERY, LLC
Practice address
286 Mitylene Park Dr
Montgomery, AL 36117-3548
Phone
(334) 396-1555
Fax
(334) 396-9833
NPI assigned
Dec 19, 2011
Last updated
Dec 19, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2012

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

Authorized official

Name
Ms. Carolyn Stone Barrett
Title
Office Manager
Phone
(334) 396-8774

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 10825 AL Primary

Addresses

Primary practice location

286 Mitylene Park Dr
Montgomery, AL 36117-3548

Mailing address

PO Box 241627
Montgomery, AL 36124-1627
Phone (334) 396-1555

Other identifiers 2

IdentifierTypeStateIssuer
528501290MedicaidAL
CM4358OtherALRAILROAD MEDICARE

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1324252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355875200000",
    "number": "1891064937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 241627",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361241627",
            "telephone_number": "334-396-1555",
            "fax_number": "334-396-9833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "286 MITYLENE PARK DR",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361173548",
            "telephone_number": "334-396-1555",
            "fax_number": "334-396-9833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY ASSOCIATES OF MONTGOMERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-19",
        "last_updated": "2012-12-19",
        "status": "A",
        "authorized_official_last_name": "BARRETT",
        "authorized_official_first_name": "CAROLYN",
        "authorized_official_middle_name": "STONE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "334-396-8774",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "AL",
            "license": "10825",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "528501290",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CM4358",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Montgomery, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2012; 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.