Provider Demographics
NPI:1093731697
Name:DERMATOLOGY ASSOCIATES OF SOUTH MS PLLC
Entity Type:Organization
Organization Name:DERMATOLOGY ASSOCIATES OF SOUTH MS PLLC
Other - Org Name:J. HUNTER PHILLIPS, III, MD, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:HUNTER
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:228-594-9904
Mailing Address - Street 1:2550 PASS ROAD
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-2112
Mailing Address - Country:US
Mailing Address - Phone:228-594-9904
Mailing Address - Fax:228-594-9962
Practice Address - Street 1:2550 PASS ROAD
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-2112
Practice Address - Country:US
Practice Address - Phone:228-594-9904
Practice Address - Fax:228-594-9962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10957207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS=========OtherEIN
MS=========OtherEIN