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BLUE RIDGE DERMATOLOGY NPI 1972978401


NPI Information

NPI: 1972978401
Provider Name: BLUE RIDGE DERMATOLOGY
Classification: Physician Assistant - 363AM0700X
Entity Type: Organization

Specialization: Medical

CLIA Number: 11D2118782

Address:
101 RIVERSTONE VIS
STE 215
BLUE RIDGE, GA
ZIP 30513
Phone: (706) 946-4227
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BLUE RIDGE DERMATOLOGY is a medical physician assistant in Blue Ridge, GA. BLUE RIDGE DERMATOLOGY NPI is 1972978401. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

101 RIVERSTONE VIS
STE 215
BLUE RIDGE, GA
ZIP 30513-648
Phone: (706) 946-4227

The provider's authorized official is Frances Lovingood .
The authorized official title is Pm and has the following contact phone number (706) 946-4227.

The CLIA number assigned to this NPI record is 11D2118782 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/9/2015 and was last updated on 12/9/2015.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363AM0700XPhysician AssistantMedical6730GEORGIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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