Organization
ADVANCED DERMATOLOGY OF SC PC
Active
Parent organization
ADVANCED DERMATOLOGY OF SC PC
Organization subpart
Yes
Provider details
NPI number
Legal business name
ADVANCED DERMATOLOGY OF SC PC
Authorized official
AMY DECLUE (DIRECTOR PROVIDER ENROLLMENT)
(407) 917-7293
Entity
Organization
Contact information
Practice address
1700 FIRST BAXTER XING STE 101, FORT MILL, SC 29708-8950
(803) 802-3376
(803) 802-3329
Mailing address
151 SOUTHHALL LN STE 300, MAITLAND, FL 32751-7172
(079) 177-2934
(407) 650-3455
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
01/06/2022
Last updated
01/06/2022
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