Organization
SOUTHERN DERMATOLOGY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN R COOK M.D. (OWNER)
(803) 644-5779
Entity
Organization
Contact information
Practice address
2110 WOODSIDE EXECUTIVE CT, AIKEN, SC 29803-3809
(803) 644-5779
Mailing address
2110 WOODSIDE EXECUTIVE CT, AIKEN, SC 29803-3809
(803) 644-5779
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
11685
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP2477
—
SC
Enumeration date
12/16/2011
Last updated
12/16/2011
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