Organization
ADVANCED DERMATOLOGY OF ALABAMA, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATT LEAVITT DO (OWNER)
(407) 875-2080
Entity
Organization
Contact information
Practice address
286 MITYLENE PARK DR, MONTGOMERY, AL 36117-3548
(407) 875-2080
(407) 650-3455
Mailing address
151 SOUTHHALL LN STE 300, MAITLAND, FL 32751-7172
(407) 875-2080
(407) 650-3455
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
207ND0900X
Dermatopathology Physician
—
—
207NS0135X
Procedural Dermatology Physician
—
—
Other
Enumeration date
09/04/2020
Last updated
09/04/2020
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