Provider Demographics
NPI:1255911293
Name:ACCESS DERMATOLOGY CLINIC
Entity type:Organization
Organization Name:ACCESS DERMATOLOGY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:TED
Authorized Official - Last Name:ALLRED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-715-2165
Mailing Address - Street 1:1945 SCOTTSVILLE RD
Mailing Address - Street 2:B-2 #192
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104
Mailing Address - Country:US
Mailing Address - Phone:702-715-2165
Mailing Address - Fax:
Practice Address - Street 1:1030 BROOKHAVEN RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:KY
Practice Address - Zip Code:42134-2745
Practice Address - Country:US
Practice Address - Phone:270-715-2165
Practice Address - Fax:270-560-3700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-13
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty