Organization
AQUA DERMATOLOGY OF ALABAMA PC
Active
Other names
Surgical Dermatology Group, Sunrise Dermatology, True Dermatology
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN LAKE (ADMINISTRATION)
(205) 977-9786
Entity
Organization
Contact information
Practice address
1940 STONEGATE DR STE 130, VESTAVIA HLS, AL 35242
(205) 977-9876
(205) 977-9976
Mailing address
1940 STONEGATE DR STE 130, VESTAVIA HLS, AL 35242-2541
(205) 977-9876
(205) 977-9976
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
20579
AL
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
20579
AL
207NS0135X
Procedural Dermatology Physician
20579
AL
Other
Enumeration date
12/01/2008
Last updated
06/25/2024
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