Provider Demographics
NPI:1174019541
Name:NORTHEAST ALABAMA DERMATOLOGY LLC
Entity Type:Organization
Organization Name:NORTHEAST ALABAMA DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:BIRCHMORE
Authorized Official - Last Name:MUSICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-536-3738
Mailing Address - Street 1:201 SIVLEY RD SW STE 410
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5146
Mailing Address - Country:US
Mailing Address - Phone:256-536-3738
Mailing Address - Fax:256-536-3737
Practice Address - Street 1:201 SIVLEY RD SW STE 410
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5146
Practice Address - Country:US
Practice Address - Phone:256-536-3738
Practice Address - Fax:256-536-3737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL13699207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty