Provider Demographics
NPI:1831548668
Name:SHADES VALLEY DERMATOLOGY, LLC
Entity type:Organization
Organization Name:SHADES VALLEY DERMATOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:H
Authorized Official - Last Name:FLANAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-578-1799
Mailing Address - Street 1:813 SHADES CREEK PKWY
Mailing Address - Street 2:STE 205
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-4542
Mailing Address - Country:US
Mailing Address - Phone:205-578-1799
Mailing Address - Fax:205-578-3158
Practice Address - Street 1:813 SHADES CREEK PKWY
Practice Address - Street 2:STE 205
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-4542
Practice Address - Country:US
Practice Address - Phone:205-578-1799
Practice Address - Fax:205-578-3158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-13
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23903207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty