SUMMIT DERMATOLOGY & LASER CENTER, P.C. (NPI# 1508920992) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508920992 |
| Entity Type | Organization |
| Organization Name | SUMMIT DERMATOLOGY & LASER CENTER, P.C. |
| Practice Address |
1111 Glynco Pkwy Bldg 1, Suite 20 Brunswick GA 31525-7921 |
| Practice Telephone | 9122621801 |
| Practice Fax Number | 9122646262 |
| Mailing Telephone | 9122621801 |
| Mailing Fax Number | 9122646262 |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2008-04-16 |
| Authorized Official Name | DR. LAWRENCE GEORGE BLASIK JR. (OWNER) |
| Authorized Official Telephone | 9122621801 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | 055102 | GA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | RR MEDICARE | DB9882 | 01 |
| Street Address |
1111 GLYNCO PKWY BLDG 1, SUITE 20 |
| City | BRUNSWICK |
| State | GA |
| Zip Code | 31525-7921 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922089713 | Northwest Diagnostic Imaging, Inc | Radiology | 1111 Glynco Pkwy, Brunswick, GA 31525-7921 | 2005-11-08 |
| 1639562978 | Tattnall Hospital Company, LLC | Orthopaedic Surgery | 1111 Glynco Pkwy, Suite 30 - A Summit Professional Plaza I, Brunswick, GA 31525-7921 | 2015-03-11 |
| 1487047726 | Optim Orthopedics, LLC | Orthopaedic Surgery | 1111 Glynco Pkwy, Suite 30 - A Summit Professional Plaza I, Brunswick, GA 31525-7921 | 2015-03-11 |
| 1376960179 | Joseph Durant | Specialist | 1111 Glynco Pkwy, Ste. 400, Brunswick, GA 31525-7921 | 2014-03-19 |
| 1760815880 | Kendra Curry | Social Worker | 1111 Glynco Pkwy, Bldg 2, Suite 200, Brunswick, GA 31525-7921 | 2013-08-12 |
| 1144575168 | Karah Lynn Brown | Physician Assistant | 1111 Glynco Pkwy, #2-100, Brunswick, GA 31525-7921 | 2012-07-16 |
| 1659643955 | Costrini & Meadows PC | Internal Medicine | 1111 Glynco Pkwy, Suite 410, Brunswick, GA 31525-7921 | 2012-02-01 |
| 1285917401 | Micah Henderson Lancaster | Physician Assistant | 1111 Glynco Pkwy, Building 1, Suite 20, Brunswick, GA 31525-7921 | 2011-09-23 |
| 1114215498 | Florida Bracing Centers, Inc. | Prosthetic/Orthotic Supplier | 1111 Glynco Pkwy, Building 2, Suite 110, Brunswick, GA 31525-7921 | 2011-07-20 |
| 1801105275 | Dublin Vamc | Clinic/Center | 1111 Glynco Pkwy, Summit Professional Plaza, Suite 200, Brunswick, GA 31525-7921 | 2010-10-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063905990 | Jonathon Wesley Capps | Physician Assistant | 1111 Glynco Pkwy Bldg 1, Ste 10, Brunswick, GA 31525 | 2018-06-14 |
| 1366993628 | Hands Down Muscle Restoration, Inc | Homeopath | 1212 Chapel Crossing Road, Brunswick, GA 31525 | 2016-10-20 |
| 1619424173 | Jebediah S Christy Dds - Brunswick Pllc | Dentist | 11455 Canal Crossing, Brunswick, GA 31525 | 2016-09-01 |
| 1831545508 | Heller Family Medicine, LLC | General Practice | 208 Scranton Connector Ste 120, Brunswick, GA 31525 | 2016-05-11 |
| 1437525391 | Natisha Danielle Hill | Occupational Therapy Assistant | 138 Wingefield Commons Drive, Brunswick, GA 31525 | 2015-08-14 |
| 1811269632 | Solar Family Practice | Family Medicine | 122 Scranton Connector, Suite 112, Brunswick, GA 31525 | 2012-02-09 |
| 1700187895 | Chetan Patel | Pharmacist | 12 Woodfall Ct, Brunswick, GA 31525 | 2010-11-05 |
| 1194914275 | Dialysis of Golden Isles, LLC | Clinic/Center | 475 Gateway Center Blvd, Brunswick, GA 31525 | 2007-10-15 |
| 1902939325 | Gateway Behavioral Health Services | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 111 Frazier Street, Brunswick, GA 31525 | 2007-03-14 |
| 1609909498 | Gateway Behavioral Health Services | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 115 Frazier Road, Brunswick, GA 31525 | 2007-03-13 |
| Find all providers in zip 31525 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346318144 | Ralph Wade Swann Jr. | Dermatology | 3215 Shrine Road, Brunswick, GA 31520 | 2006-12-01 |
| 1689656720 | Edward A Dipreta | Dermatology | 3008 E Park Ave, Brunswick, GA 31520-4241 | 2005-11-15 |
| 1013916410 | Nancy Egan | Dermatology | 14 Maine St, Suite 201, Brunswick, ME 04011-2026 | 2005-07-18 |
| 1023377140 | Mid Coast Dermatology, LLC | Dermatology | 85 Baribeau Dr, Suite 1, Brunswick, ME 04011-3249 | 2012-05-09 |
| 1952587297 | Edward Dipreta Md PC | Dermatology | 3008 E Park Ave, Brunswick, GA 31520-4241 | 2008-01-17 |
| 1952519043 | Jennifer Dawn Bahner | Dermatology | 4065 Center Rd, Ste 214, Brunswick, OH 44212-2918 | 2007-05-20 |
| 1255478541 | Helge G Riemann | Dermatology | 85 Baribeau Dr, Suite #1, Brunswick, ME 04011-3249 | 2007-01-30 |
| 1427159946 | Cvp Md PC | Dermatology | 3008 E Park Ave, Brunswick, GA 31520-4241 | 2006-09-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720686058 | Worldwide Medical Healthcare Inc | Dermatology | 790 Church St Ne Ste 300, Marietta, GA 30060-8902 | 2020-10-09 |
| 1972142891 | Worldwide Medical Distributor, LLC | Dermatology | 3780 Old Norcross Rd Ste 103, Duluth, GA 30096-1762 | 2019-12-23 |
| 1932762218 | Laura Quinn Biehle | Dermatology | 5730 Glenridge Dr Ste T100, Atlanta, GA 30328-5747 | 2019-04-22 |
| 1003479254 | Kiley Katherine Fagan | Dermatology | 775 Aronson Lake Ct, Roswell, GA 30075-7172 | 2019-04-15 |
| 1346700127 | Gerald Chotiner | Dermatology | 2887 Gant Qtrs. Circle, Marietta, GA 30068-3719 | 2019-03-20 |
| 1205308616 | Belle Lumiere Cosmetics LLC | Dermatology | 753 Old Norcross Road, Lawrenceville, GA 30046 | 2018-12-24 |
| 1154890564 | Sidney Adele Brown-caggiano | Dermatology | 4645 Timber Ridge Dr Ste 100, Douglasville, GA 30135-7542 | 2018-11-14 |
| 1194209163 | Live Oak Dermatology | Dermatology | 135 Norcross St # 8, Roswell, GA 30075-3867 | 2018-09-17 |
| 1942780994 | Skyn Clinic & Apothecary | Dermatology | 1150 Peachtree Industrial Blvd Ste 165, Suwanee, GA 30024-1903 | 2018-08-20 |
| 1649750688 | Zola Nemorin | Dermatology | 1500 Peachtree Industrial Blvd Ste 165, Suwanee, GA 30024-8490 | 2018-08-20 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on SUMMIT DERMATOLOGY & LASER CENTER, P.C..
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.