ADULT & PEDIATRIC DERMATOLOGY OF TULLAHOMA PC (NPI# 1881658243) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881658243 |
| Entity Type | Organization |
| Organization Name | ADULT & PEDIATRIC DERMATOLOGY OF TULLAHOMA PC |
| Practice Address |
100 William Northern Blvd Ste C Tullahoma TN 37388 |
| Practice Telephone | 9314557400 |
| Practice Fax Number | 9314556344 |
| Mailing Telephone | 9314557400 |
| Mailing Fax Number | 9314556344 |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2009-12-03 |
| Authorized Official Name | DR. KEN T TAKEGAMI (PRESIDENT) |
| Authorized Official Telephone | 9314557400 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
MD0000021099 | TN | Allopathic & Osteopathic Physicians |
| N | 207ND0900X |
Dermatology Specialization: Dermatopathology |
MD0000021099 | TN | Allopathic & Osteopathic Physicians |
| Y | 207N00000X | Dermatology | MD0000021099 | TN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | 3373903 | 05 |
| Street Address |
100 WILLIAM NORTHERN BLVD STE C |
| City | TULLAHOMA |
| State | TN |
| Zip Code | 37388 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841800851 | Arthur Davies Md, Pllc | Family Medicine | 100 William Northern Blvd, Tullahoma, TN 37388-4754 | 2020-08-04 |
| 1093340630 | Tara Beth Tye | Nurse Practitioner | 100 William Northern Blvd, Tullahoma, TN 37388-4754 | 2020-03-04 |
| 1295268654 | Jennifer Tallman | Nurse Practitioner | 100 William Northern Blvd, Tullahoma, TN 37388-4754 | 2017-04-04 |
| 1770821365 | Arthur Davies | Emergency Medicine | 100 William Northern Blvd, Tullahoma, TN 37388-4754 | 2013-01-17 |
| 1851546469 | Lauren E Martin | Physician Assistant | 100 William Northern Blvd, Tullahoma, TN 37388-5407 | 2008-11-24 |
| 1275796880 | Family Practice Center of Tullahoma LLC | Family Medicine | 100 William Northern Blvd, Tullahoma, TN 37388-4754 | 2008-07-03 |
| 1235304213 | John D Patsimas Md | Family Medicine | 100 William Northern Blvd, Tullahoma, TN 37388-4754 | 2008-04-29 |
| 1881869865 | Olan B Kemp | Family Medicine | 100 William Northern Blvd, Tullahoma, TN 37388-4754 | 2008-04-29 |
| 1154596120 | Donald Tucker Pllc | Internal Medicine | 100 William Northern Blvd, Tullahoma, TN 37388-4754 | 2008-04-29 |
| 1932251873 | Ken T Takegami | Dermatology | 100 William Northern Blvd, Suite C, Tullahoma, TN 37388 | 2007-01-18 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588183628 | Angela Michelle Sowers | Dietitian, Registered | 1801 North Jackson St, Tullahoma, TN 37388 | 2017-09-09 |
| 1194242669 | Haley D Stewart | Speech-Language Pathologist | Top Rehab Services, Inc, 2110 N. Jackson Street, Tullahoma, TN 37388 | 2017-08-25 |
| 1295263150 | Kelli Elaine Spencer | Nurse Practitioner | Partners for Healing, 109 West Blackwell Street, Tullahoma, TN 37388 | 2017-05-23 |
| 1932651486 | Adam Snider | Physical Therapy Assistant | 1321 Cedar Lane, Tullahoma, TN 37388 | 2016-11-01 |
| 1891240743 | Elizabeth Riddle | Nurse Practitioner | 1805 N Jackson St Ste 11, Tullahoma, TN 37388 | 2016-08-22 |
| 1720437189 | Ronda Schrimsher | Peer Specialist | 108 E Lauderdale St, Tullahoma, TN 37388 | 2016-06-07 |
| 1003298639 | Jeanetta Clark | Counselor | 1803 N. Jackson St, Centerstone of Tennessee, Tullahoma, TN 37388 | 2015-06-19 |
| 1285051698 | Ashley Mcmurtry | Physical Therapist | 2110 N. Jackson Street, Tullahoma, TN 37388 | 2014-03-24 |
| 1093150575 | Orthopedic Braces | Case Management | 206 Westside Dr, Tullahoma, TN 37388 | 2013-05-09 |
| 1427397199 | Kristina Danette Carter | Pharmacist | 104 North Jackson Street, Tullahoma, TN 37388 | 2013-01-31 |
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| 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 |
|---|---|---|---|---|
| 1558708701 | Isaac Gene Bryan | Dermatology | 1330 Cedar Ln Ste 700, Tullahoma, TN 37388-3276 | 2013-05-29 |
| 1154948669 | Tullahoma Dermatology PC | Dermatology | 1330 Cedar Ln Ste 700, Tullahoma, TN 37388-3276 | 2020-06-30 |
| 1932251873 | Ken T Takegami | Dermatology | 100 William Northern Blvd, Suite C, Tullahoma, TN 37388 | 2007-01-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356964274 | Harpeth Valley Dermatology Pllc | Dermatology | 741 President Pl Ste 140, Smyrna, TN 37167-6808 | 2020-05-27 |
| 1538717202 | Christopher Reeder | Dermatology | 6453 Drumright Rd, College Grove, TN 37046-9142 | 2019-08-27 |
| 1346719085 | Skinmd Center Pllc | Dermatology | 751 Walnut Knoll Lane, Suite 2, Cordova, TN 38018-6301 | 2018-11-23 |
| 1467968859 | Outreach Clinics Unlimited Pllc | Dermatology | 1627 Old Gray Station Rd Ste 4, Johnson City, TN 37615-4193 | 2017-12-20 |
| 1295289114 | Firstcare Dermatology of Lawrenceburg, Pllc | Dermatology | 1002 N Locust Ave, Lawrenceburg, TN 38464-2707 | 2016-08-09 |
| 1790158012 | Joseph Prohaska | Dermatology | 1907 W Morris Blvd Ste G, Morristown, TN 37813-3866 | 2015-11-09 |
| 1346637048 | Jonathan Allen Miller | Dermatology | 5243 Little Debbie Pkwy Ste 111, Ooltewah, TN 37363-4515 | 2015-04-20 |
| 1073909156 | Neelam Patel | Dermatology | 470 Jones Rd, Clarksville, TN 37043-4005 | 2015-04-15 |
| 1013315373 | Robert J Kaplan, Md Pllc | Dermatology | 6401 Poplar Ave Ste 330, Memphis, TN 38119-4806 | 2014-12-18 |
| 1538575709 | Emily Dell | Dermatology | 1009 N State of Franklin Rd, Johnson City, TN 37604 | 2014-07-08 |
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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.