Provider Demographics
NPI:1134700131
Name:SSD, LLC
Entity Type:Organization
Organization Name:SSD, LLC
Other - Org Name:SOUTHERN SKIES DERMATOLOGY AND SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:MARUTHUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-900-2000
Mailing Address - Street 1:48 MEDICAL PARK DR E STE 458
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-3473
Mailing Address - Country:US
Mailing Address - Phone:205-838-1811
Mailing Address - Fax:205-838-4525
Practice Address - Street 1:48 MEDICAL PARK DR E STE 458
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3473
Practice Address - Country:US
Practice Address - Phone:205-838-1811
Practice Address - Fax:205-838-4525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-20
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty