Provider Demographics
NPI:1184861668
Name:HAYMONT SKIN CENTER, PA
Entity Type:Organization
Organization Name:HAYMONT SKIN CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:INAD
Authorized Official - Middle Name:BADREDDIN
Authorized Official - Last Name:ATASSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-321-7546
Mailing Address - Street 1:1008 HAY ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5316
Mailing Address - Country:US
Mailing Address - Phone:910-321-7546
Mailing Address - Fax:
Practice Address - Street 1:1008 HAY ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5316
Practice Address - Country:US
Practice Address - Phone:910-321-7546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24630207Q00000X, 207T00000X
NC102748363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty