Provider Demographics
NPI:1619213204
Name:CAHABA DERMATOLOGY & SKIN HEALTH CENTER, LLC
Entity Type:Organization
Organization Name:CAHABA DERMATOLOGY & SKIN HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VLADA
Authorized Official - Middle Name:
Authorized Official - Last Name:GROYSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:205-214-7546
Mailing Address - Street 1:2279 VALLEYDALE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-2111
Mailing Address - Country:US
Mailing Address - Phone:205-214-7546
Mailing Address - Fax:
Practice Address - Street 1:2279 VALLEYDALE RD STE 100
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-2111
Practice Address - Country:US
Practice Address - Phone:205-214-7546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-31
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL28104207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty