Provider Demographics
NPI:1376970236
Name:SKIN PATHOLOGY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:SKIN PATHOLOGY ASSOCIATES, LLC
Other - Org Name:SKIN PATHOLOGY ASSOCIATES, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HIGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-949-2834
Mailing Address - Street 1:3560 INDEPENDENCE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-5703
Mailing Address - Country:US
Mailing Address - Phone:205-949-2806
Mailing Address - Fax:205-949-2810
Practice Address - Street 1:3550 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-5710
Practice Address - Country:US
Practice Address - Phone:205-949-2806
Practice Address - Fax:205-949-2810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-08
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL37107207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathologyGroup - Multi-Specialty