Provider Demographics
NPI:1639272065
Name:DERMATOLOGY & SKIN CANCER CENTER
Entity type:Organization
Organization Name:DERMATOLOGY & SKIN CANCER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHARKEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-328-1433
Mailing Address - Street 1:PO BOX 6898
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208
Mailing Address - Country:US
Mailing Address - Phone:478-328-0281
Mailing Address - Fax:478-328-0438
Practice Address - Street 1:2400 BELLEVUE RD
Practice Address - Street 2:16 ERIN OFC PRK
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021
Practice Address - Country:US
Practice Address - Phone:478-275-2694
Practice Address - Fax:478-328-0438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty