Provider Demographics
NPI:1720225501
Name:CHARLOTTE DERMATOLOGY,PA
Entity Type:Organization
Organization Name:CHARLOTTE DERMATOLOGY,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:B
Authorized Official - Last Name:SLAUGHTER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:704-364-6110
Mailing Address - Street 1:2630 E SEVENTH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-4318
Mailing Address - Country:US
Mailing Address - Phone:704-364-6110
Mailing Address - Fax:704-364-4245
Practice Address - Street 1:660 SINGLETON RIDGE RD
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-9154
Practice Address - Country:US
Practice Address - Phone:866-985-3376
Practice Address - Fax:704-364-4245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC31329174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty