Organization
INTRACOASTAL DERMATOLOGY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENDALL ADKISSON M.D. (MANAGER)
(904) 655-5310
Entity
Organization
Contact information
Practice address
4776 HODGES BLVD STE 105, JACKSONVILLE, FL 32224-7218
(904) 655-5310
Mailing address
4776 HODGES BLVD STE 105, JACKSONVILLE, FL 32224-7218
(904) 655-5310
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
ME110325
FL
Other
Enumeration date
11/01/2012
Last updated
01/24/2022
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