Provider Demographics
NPI:1801969480
Name:ADVANCED DERMATOLOGY & SKIN CARE SPECIALISTS, LLC
Entity type:Organization
Organization Name:ADVANCED DERMATOLOGY & SKIN CARE SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:H
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-235-3660
Mailing Address - Street 1:1419 HAMRIC DR E
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OXFORD
Mailing Address - State:AL
Mailing Address - Zip Code:36203-1933
Mailing Address - Country:US
Mailing Address - Phone:256-235-3660
Mailing Address - Fax:256-235-3663
Practice Address - Street 1:1419 HAMRIC DR E
Practice Address - Street 2:SUITE 101
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203-1933
Practice Address - Country:US
Practice Address - Phone:256-235-3660
Practice Address - Fax:256-235-3663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0023813207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529908960Medicaid
AL51503704OtherBC BS ALABAMA DR RAY
AL051556655Medicaid
AL0051503704Medicaid
AL51503704OtherBC BS ALABAMA DR RAY
AL051503704Medicare ID - Type UnspecifiedSHELLEY RAY MD PROVIDER
AL529908960Medicaid
AL051556655Medicare ID - Type UnspecifiedJESSICA DAVIS PA