Provider Demographics
NPI:1164764528
Name:DERMLAB, LLC
Entity Type:Organization
Organization Name:DERMLAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:PARRISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-566-8047
Mailing Address - Street 1:3918 MONTCLAIR RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MOUNTAIN BRK
Mailing Address - State:AL
Mailing Address - Zip Code:35213-2425
Mailing Address - Country:US
Mailing Address - Phone:205-705-3550
Mailing Address - Fax:205-705-3554
Practice Address - Street 1:3918 MONTCLAIR RD
Practice Address - Street 2:SUITE 105
Practice Address - City:MOUNTAIN BRK
Practice Address - State:AL
Practice Address - Zip Code:35213-2425
Practice Address - Country:US
Practice Address - Phone:205-705-3550
Practice Address - Fax:205-705-3554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathologyGroup - Single Specialty