Provider Demographics
NPI:1528216314
Name:ACACIA DERMATOLOGY
Entity Type:Organization
Organization Name:ACACIA DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-762-6545
Mailing Address - Street 1:2131 N LOCUST AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-4455
Mailing Address - Country:US
Mailing Address - Phone:931-762-6545
Mailing Address - Fax:931-762-6781
Practice Address - Street 1:2131 N LOCUST AVE
Practice Address - Street 2:SUITE D
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-4455
Practice Address - Country:US
Practice Address - Phone:931-762-6545
Practice Address - Fax:931-762-6781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2014-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43761174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty