Basic Information
| Provider Information | |||||||||
| NPI: | 1689993156 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DERMATOLOGY OF NORTH ALABAMA, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2307 HOMER CLAYTON DR | ||||||||
| Address2: | |||||||||
| City: | GUNTERSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 359762205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565718770 | ||||||||
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| Address1: | 2307 HOMER CLAYTON DR | ||||||||
| Address2: | |||||||||
| City: | GUNTERSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 359762205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2054221593 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2010 | ||||||||
| LastUpdateDate: | 07/31/2010 | ||||||||
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| AuthorizedOfficialLastName: | WHARTON | ||||||||
| AuthorizedOfficialFirstName: | JOSHUA | ||||||||
| AuthorizedOfficialMiddleName: | B. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2054221593 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.