Organization
COOSA RIVER DERMATOLOGY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELSEY REAL KENNEDY MD (PRESIDENT/CEO)
(205) 514-1664
Entity
Organization
Contact information
Practice address
1242 MARTIN ST S STE B, PELL CITY, AL 35128-2310
(205) 514-1664
Mailing address
PO BOX 932, TRUSSVILLE, AL 35173-0932
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
—
—
Other
Enumeration date
04/09/2024
Last updated
04/09/2024
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