Provider Demographics
NPI:1467728238
Name:DERMATOLOGY ASSOCIATES OF WACCAMAW LLC
Entity Type:Organization
Organization Name:DERMATOLOGY ASSOCIATES OF WACCAMAW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:C
Authorized Official - Last Name:GASKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-652-8160
Mailing Address - Street 1:PO BOX 2010
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-2010
Mailing Address - Country:US
Mailing Address - Phone:843-652-8100
Mailing Address - Fax:843-652-8122
Practice Address - Street 1:4033 HWY 17 BYPASS
Practice Address - Street 2:STE 105
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-5032
Practice Address - Country:US
Practice Address - Phone:843-652-8100
Practice Address - Fax:843-652-8122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty