Organization
ATLANTIC DERMATOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KRISTIN WIDICK SMALLWOOD M.D. (PRESIDENT)
(321) 784-8811
Entity
Organization
Contact information
Practice address
1980 N ATLANTIC AVE, SUITE 722, COCOA BEACH, FL 32931-5213
(321) 784-8811
(321) 799-4424
Mailing address
1980 N ATLANTIC AVE, SUITE 722, COCOA BEACH, FL 32931-5213
(321) 784-8811
(321) 799-4424
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
—
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
—
—
207NP0225X
Pediatric Dermatology Physician
—
—
207NS0135X
Procedural Dermatology Physician
Primary
—
—
Other
Enumeration date
08/31/2006
Last updated
09/11/2025
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