Provider Demographics
NPI:1437109899
Name:LANIER DERMATOLOGY & SKIN CANCER SPECIALISTS, PC
Entity Type:Organization
Organization Name:LANIER DERMATOLOGY & SKIN CANCER SPECIALISTS, PC
Other - Org Name:KEVIN L. SMITH, MD PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-538-0208
Mailing Address - Street 1:605 S ENOTA DR NE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-2437
Mailing Address - Country:US
Mailing Address - Phone:770-538-0208
Mailing Address - Fax:770-538-0556
Practice Address - Street 1:605 S ENOTA DR NE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2437
Practice Address - Country:US
Practice Address - Phone:770-538-0208
Practice Address - Fax:770-538-0556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1487604021OtherBCBS
GA0005756529OtherAETNA
GA000814767AMedicaid
GA070015990OtherRAILROAD MEDICARE
GACH9982OtherRAILROAD MEDICARE
GA0007735230OtherAETNA
GA1306896931OtherBCBS
GA000678983BMedicaid
GA070011202OtherRAILROAD MEDICARE
GAF75192Medicare UPIN
GA000814767AMedicaid
GA22BDCQKMedicare PIN
GACH9982OtherRAILROAD MEDICARE
GAH03427Medicare UPIN