Provider Demographics
NPI:1467527150
Name:ANDERSON DERMATOLOGY AND SKIN SURGERY CENTER
Entity Type:Organization
Organization Name:ANDERSON DERMATOLOGY AND SKIN SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:G
Authorized Official - Last Name:KNOEPP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-716-0063
Mailing Address - Street 1:1501 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-4734
Mailing Address - Country:US
Mailing Address - Phone:864-716-0063
Mailing Address - Fax:864-716-0073
Practice Address - Street 1:1501 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-4734
Practice Address - Country:US
Practice Address - Phone:864-716-0063
Practice Address - Fax:864-716-0073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty