# ADVANCED DERMATOLOGY CARE A PROFESSIONAL MEDICAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1336439553
- **Authorized official:** DR. LORETTA PYLANT GREMILLION M.D. (OWNER)
- **Authorized official phone:** (318) 323-8799

## Contact information

- **Practice address:** 2409 BROADMOOR BLVD, MONROE, LA 71201-2964
- **Practice address phone:** (318) 323-8799
- **Practice address fax:** (318) 323-8815
- **Mailing address:** 1868 FORSYTHE AVE STE 335, MONROE, LA 71201-3540
- **Mailing address phone:** (318) 323-8799

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 026501 | LA | Yes |

## Other

- **Enumeration date:** 04/08/2011
- **Last updated:** 07/12/2018