Provider Demographics
NPI:1982138715
Name:SKIN SOLUTION TO MASSAGE
Entity Type:Organization
Organization Name:SKIN SOLUTION TO MASSAGE
Other - Org Name:SKIN SOLUTION MED SPA
Other - Org Type:Other Name
Authorized Official - Title/Position:ONWER
Authorized Official - Prefix:MR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-952-3199
Mailing Address - Street 1:1 CHICK SPRINGS RD STE 207A
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-4976
Mailing Address - Country:US
Mailing Address - Phone:843-952-3199
Mailing Address - Fax:
Practice Address - Street 1:1 CHICK SPRINGS RD STE 207A
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-4976
Practice Address - Country:US
Practice Address - Phone:843-952-3199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty