SKIN IN THE GAME, PLLC (NPI# 1760043046) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760043046 |
| Entity Type | Organization |
| Organization Name | SKIN IN THE GAME, PLLC |
| Other Organization Name | THE DERMATOLOGY CLINIC |
| Practice Address |
6510 Highway 90 Gautier MS 39553-5015 |
| Mailing Address |
Po Box 6625 Gulfport MS 39506-6625 |
| Practice Telephone | 2288643300 |
| Practice Fax Number | 2288643333 |
| Mailing Telephone | 2288643300 |
| Mailing Fax Number | 2288643333 |
| Enumeration Date | 2019-06-26 |
| Last Update Date | 2020-05-06 |
| Authorized Official Name | LEAANN BORMANN (PRACTICE MANAGER) |
| Authorized Official Telephone | 2288643300 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 09474302 | 05 | |
| MS | MEDICARE | 909605 | 01 |
| Other Name | Type Code |
|---|---|
| The Dermatology Clinic | Doing Business As Name - Organization |
| Street Address |
6510 HIGHWAY 90 |
| City | GAUTIER |
| State | MS |
| Zip Code | 39553-5015 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205465044 | Loggan Malone | Dentist | 2808 Us-90 W, Gautier, MS 39553 | 2020-04-03 |
| 1770979775 | Catherine Durham | Counselor | 3407 Shamrock Dr., Gautier, MS 39553 | 2015-04-07 |
| 1851648836 | Pharmatex, LLC | Pharmacy | 4551-d Gautier Vancleave Road, Gautier, MS 39553 | 2012-08-09 |
| 1891957544 | David W Bonderer Dds Pllc | Dentist | 2808 Hwy 90, Suite 1, Gautier, MS 39553 | 2008-06-25 |
| 1790830313 | William D Parrish | Dentist | 713 Us Hwy 90, Gautier, MS 39553 | 2007-01-24 |
| 1073685830 | Jeffrey Lamone Knight | Dentist | 3105 Shaw Dr., Gautier, MS 39553 | 2006-11-15 |
| 1720178437 | Erica B Wilson | Counselor | 3704 Shamrock Court, Gautier, MS 39553 | 2006-10-13 |
| 1881781631 | James D Victory | Chiropractor | 315 Highway 90, Gautier, MS 39553 | 2006-10-05 |
| 1508959180 | Robert Douglas Holbert | Internal Medicine | 2105 Old Spanish Trail, Gautier, MS 39553 | 2006-10-02 |
| 1962508119 | Sentry-gautier, Inc. | Nursing Facility/Intermediate Care Facility | 5090 Gautier Vancleave Road, Gautier, MS 39553 | 2006-09-15 |
| Find all providers in zip 39553 | ||||
| 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 |
|---|---|---|---|---|
| 1407296825 | Ashley Nicole Emerson | Dermatology | 6510 Highway 90 Ste C, Gautier, MS 39553-5015 | 2013-06-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427535079 | Jenna Joe Rose Cooper | Dermatology | 2204 Jefferson Davis Dr, Oxford, MS 38655-5222 | 2018-07-26 |
| 1427460849 | Anna Allred Wile | Dermatology | 4331 Highway 39 N Ste A, Meridian, MS 39301-1007 | 2014-05-21 |
| 1134558331 | South Central Clinics, Inc | Dermatology | 920 Matthew Dr Ste 8, Waynesboro, MS 39367-2553 | 2013-11-07 |
| 1265729719 | Jasmine C. Hollinger | Dermatology | 2080 S Frontage Rd Ste 113, Vicksburg, MS 39180-5882 | 2011-07-06 |
| 1295022861 | Kenneth Daniel Saul | Dermatology | 5002 Highway 39 N Bldg A, Meridian, MS 39301-1078 | 2011-07-05 |
| 1689969735 | Adam C Byrd | Dermatology | 313 N Court Ave, Ummc Dermatology - Louisville Clinic, Louisville, MS 39339 | 2011-06-16 |
| 1063724987 | Lyndsay R Shipp | Dermatology | 705 Sisk Ave Ste 105, Oxford, MS 38655-3413 | 2010-07-08 |
| 1144545195 | Lisa Renee Chastant | Dermatology | 81 Mdos/sgomd, 301 Fisher St., Keesler Afb, MS 39534-2519 | 2010-04-01 |
| 1982836037 | Bethany R Hairston Md | Dermatology | 724 Leigh Drive, Columbus, MS 39705-3098 | 2009-08-21 |
| 1639343312 | Lena Elizabeth Gowring | Dermatology | 301 Fisher St Ste 5a, Keesler Afb, MS 39534-2508 | 2008-04-15 |
| Find all providers with the same taxonomy | ||||
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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.