Provider Demographics
NPI:1003213273
Name:DERMATOLOGY CENTER SOUTH PC
Entity Type:Organization
Organization Name:DERMATOLOGY CENTER SOUTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SEBASTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HEERSINK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-793-2211
Mailing Address - Street 1:2800 ROSS CLARK CIR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-2040
Mailing Address - Country:US
Mailing Address - Phone:334-793-2211
Mailing Address - Fax:
Practice Address - Street 1:2800 ROSS CLARK CIR
Practice Address - Street 2:SUITE 1
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-2040
Practice Address - Country:US
Practice Address - Phone:334-793-2211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty