Provider Demographics
NPI:1366075343
Name:DERMATOLOGY AND SKIN SURGERY INC
Entity type:Organization
Organization Name:DERMATOLOGY AND SKIN SURGERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SHAREHOLDER /CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:L
Authorized Official - Last Name:LATHAM
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:803-775-4469
Mailing Address - Street 1:560 CONSTITUTION DR
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29154-8175
Mailing Address - Country:US
Mailing Address - Phone:803-775-4469
Mailing Address - Fax:803-775-4981
Practice Address - Street 1:560 CONSTITUTION DR
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29154-8175
Practice Address - Country:US
Practice Address - Phone:803-775-4469
Practice Address - Fax:803-775-4981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-18
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty