Organization
SKIN IN THE GAME, PLLC
Active
Other names
The Dermatology Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
HOLLY HARLAN (PRACTICE MANAGER)
(228) 864-3300
Entity
Organization
Contact information
Practice address
6510 HIGHWAY 90, GAUTIER, MS 39553-5015
(228) 864-3300
(228) 864-3333
Mailing address
PO BOX 6625, GULFPORT, MS 39506-6625
(228) 864-3300
(228) 864-3333
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09474302
—
MS
01
—
909605
MEDICARE
MS
Enumeration date
06/26/2019
Last updated
02/24/2023
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