Provider Demographics
NPI:1265024186
Name:SOUTHERN DERMATOLOGY MEDICAL LLC
Entity type:Organization
Organization Name:SOUTHERN DERMATOLOGY MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DERMATOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:BRIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:412-995-0025
Mailing Address - Street 1:4158 WASHINGTON RD STE 9
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-4720
Mailing Address - Country:US
Mailing Address - Phone:706-760-0013
Mailing Address - Fax:
Practice Address - Street 1:3555 RICHLAND AVE W STE 174
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-6410
Practice Address - Country:US
Practice Address - Phone:803-335-0066
Practice Address - Fax:762-224-2177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-11
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty