Provider Demographics
NPI:1083709844
Name:CHATHAM SKIN AND CANCER CENTER
Entity Type:Organization
Organization Name:CHATHAM SKIN AND CANCER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:NADINE
Authorized Official - Last Name:GAUGHF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-354-7124
Mailing Address - Street 1:639 STEPHENSON AVE.
Mailing Address - Street 2:A
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5970
Mailing Address - Country:US
Mailing Address - Phone:912-354-7124
Mailing Address - Fax:912-353-8944
Practice Address - Street 1:639 STEPHENSON AVE.
Practice Address - Street 2:A
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5970
Practice Address - Country:US
Practice Address - Phone:912-354-7124
Practice Address - Fax:912-353-8944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037810207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG50199Medicare UPIN
GAGRP4191Medicare ID - Type Unspecified