ADVANCED DERMATOLOGY OF ALABAMA, INC. (NPI# 1538773775) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1538773775 |
| Entity Type | Organization |
| Organization Name | ADVANCED DERMATOLOGY OF ALABAMA, INC. |
| Practice Address |
286 Mitylene Park Dr Montgomery AL 36117-3548 |
| Mailing Address |
151 Southhall Ln Ste 300 Maitland FL 32751-7172 |
| Practice Telephone | 4078752080 |
| Practice Fax Number | 4076503455 |
| Mailing Telephone | 4078752080 |
| Mailing Fax Number | 4076503455 |
| Enumeration Date | 2020-09-04 |
| Last Update Date | 2020-09-04 |
| Authorized Official Name | MATT LEAVITT (OWNER) |
| Authorized Official Telephone | 4078752080 |
| Authorized Official Credential | DO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
Allopathic & Osteopathic Physicians | ||
| N | 207ND0900X |
Dermatology Specialization: Dermatopathology |
Allopathic & Osteopathic Physicians | ||
| N | 207NS0135X |
Dermatology Specialization: Procedural Dermatology |
Allopathic & Osteopathic Physicians | ||
| Y | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians |
| Street Address |
286 MITYLENE PARK DR |
| City | MONTGOMERY |
| State | AL |
| Zip Code | 36117-3548 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114037215 | Elizabeth Ann Mountcastle | Dermatology | 286 Mitylene Park Dr, Montgomery, AL 36117-3548 | 2006-08-30 |
| 1891064937 | Dermatology Associates of Montgomery, LLC | Specialist | 286 Mitylene Park Dr, Montgomery, AL 36117-3548 | 2011-12-19 |
| 1306902127 | James Stephen Maddox | Dermatology | 286 Mitylene Park Dr, Montgomery, AL 36117 | 2006-12-28 |
| 1720188196 | James Stephen Maddox | Dermatology | 286 Mitylene Park Dr, Montgomery, AL 36117-3548 | 2006-09-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568061307 | Bhg Lxxiii, LLC | Clinic/Center | 1714 Platt Place, Montgomery, AL 36117 | 2020-10-22 |
| 1952945602 | East Montgomery Pediatrics LLC | Pediatrics | 337 St Lukes Drive, Montgomery, AL 36117 | 2019-11-05 |
| 1417421496 | Tiffany Webb | Specialist | 411 Twain Curve, E, Montgomey, AL 36117 | 2019-01-14 |
| 1013485374 | Montgomery Orthodontic Specialists | Dentist | 5833 Carmichael Road, Montgomery, AL 36117 | 2018-11-05 |
| 1770050791 | Blair Henderson Parks | Speech-Language Pathologist | 7088 University Court, Montgomery, AL 36117 | 2018-10-29 |
| 1629557822 | Evelyn F Crayton | Dietitian, Registered | 124 Elm Dr, Montgomery, AL 36117 | 2018-08-08 |
| 1194203414 | Coopers Mental Healh Consultations | Psychologist | 8743 Ridgestone Ct, Montgomery, AL 36117 | 2018-07-30 |
| 1063912301 | Gardenia Cove Mental Health PC | Psychiatry & Neurology | 6771 Taylor Circle, Montgomery, AL 36117 | 2018-02-13 |
| 1760900294 | Montgomery Auburn Homecare LLC | In Home Supportive Care | 2569 Bell Rd, Montgomery, AL 36117 | 2017-09-05 |
| 1336667120 | Alyssa Bryanna Swisher | Chiropractor | 2026 Berryhill Road, Montgomery, AL 36117 | 2017-09-01 |
| Find all providers in zip 36117 | ||||
| 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 |
|---|---|---|---|---|
| 1184790479 | John Lee Anthony | Dermatology | 4712 Berry Blvd, Montgomery, AL 36106-3080 | 2006-11-28 |
| 1114037215 | Elizabeth Ann Mountcastle | Dermatology | 286 Mitylene Park Dr, Montgomery, AL 36117-3548 | 2006-08-30 |
| 1104897073 | Mark D. Herron, M.d. L.L.C. | Dermatology | 7260 Halcyon Summit Dr, Montgomery, AL 36117-7047 | 2006-01-30 |
| 1699128009 | River Region Dermatology and Laser Inc | Dermatology | 2060 Berryhill Rd, Montgomery, AL 36117-8965 | 2016-07-20 |
| 1881911204 | Katherine Jane Bodiford | Dermatology | 7260 Halcyon Summit Dr, Montgomery, AL 36117-7047 | 2010-04-25 |
| 1164748117 | Aesthetic Dermatology | Dermatology | 300 Taylor Rd, Suite 800, Montgomery, AL 36117-3521 | 2010-04-15 |
| 1982877619 | Montgomery Dermatology, P.C. | Dermatology | 4712 Berry Blvd, Montgomery, AL 36106-3080 | 2008-04-02 |
| 1275722100 | James D. Smith, M.d. | Dermatology | 1722 Pine St, Suite 408, Montgomery, AL 36106-1103 | 2007-10-16 |
| 1386793925 | Nga Athena Phan | Dermatology | 300 Taylor Rd, Suite 100, Montgomery, AL 36117-3521 | 2007-01-10 |
| 1326195124 | Porcia Bradford Love | Dermatology | 4712 Berry Blvd, Montgomery, AL 36106-3080 | 2007-01-04 |
| Find all providers in MONTGOMERY | ||||
| City | MONTGOMERY |
| Zip Code | 36117 |
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| 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.