Provider Demographics
NPI:1689922668
Name:SKIN DIAGNOSTICS GROUP, PC
Entity Type:Organization
Organization Name:SKIN DIAGNOSTICS GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-879-2260
Mailing Address - Street 1:3125 INDEPENDENCE DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-4159
Mailing Address - Country:US
Mailing Address - Phone:205-879-2260
Mailing Address - Fax:205-879-2261
Practice Address - Street 1:3125 INDEPENDENCE DR
Practice Address - Street 2:SUITE 301
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-4159
Practice Address - Country:US
Practice Address - Phone:205-879-2260
Practice Address - Fax:205-879-2261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-22
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL25042291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory