DERMATOLOGY ASSOCIATES OF COASTAL CAROLINA
NPI 1033459011
Dermatology - Clinical & Laboratory Dermatological Immunology in Jacksonville, NC

Q: What is Dermatology Associates Of Coastal Carolina's specialty?

The primary specialty registered for this NPI is Dermatology, specializing in Clinical & Laboratory Dermatological Immunology, with taxonomy code 207NI0002X.

Active since February 27, 2013CLIA 34D2056673 · Certificate of Compliance

2145 COUNTRY CLUB RD, JACKSONVILLE, NC 28546(252) 633-4461(252) 633-6016 Get Directions Write a Review

NPPES record last updated: September 21, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Dermatology Associates Of Coastal Carolina NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DERMATOLOGY ASSOCIATES OF COASTAL CAROLINA (NPI 1033459011) is a healthcare organization registered as a clinical & laboratory dermatological immunology in Jacksonville, North Carolina and active in the NPI registry since February 2013. The organization holds a CLIA Certificate of Compliance certificate valid through March 26, 2028 and lists James Polo, Md/owner, as its authorized official.

NPPES Registry Identity

NPI1033459011

Entity TypeOrganization

Primary Taxonomy207NI0002X

Legal Business NameDERMATOLOGY ASSOCIATES OF COASTAL CAROLINA

Location Address2145 COUNTRY CLUB RDJacksonville, NC 28546-2403

Mailing AddressPo Box 890283Charlotte, NC 28289-0283 · (252) 633-4461 · Fax (252) 633-6016

Phone(252) 633-4461

Fax(252) 633-6016

Organization SubpartNo

Authorized OfficialJames PoloMd/owner · (252) 633-4461

Enumeration DateFebruary 27, 2013

Last NPPES UpdateSeptember 21, 2022

NPPES CertifiedSeptember 21, 2022

✔ NPI 1033459011 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatology · Clinical & Laboratory Dermatological ImmunologyAllopathic & Osteopathic Physicians

Taxonomy Code207NI0002X

Definition

A dermatologist who utilizes various specialized laboratory procedures to diagnose disorders characterized by defective responses of the body's immune system. Immunodermatologists also may provide consultation in the management of these disorders and administer specialized forms of therapy for these diseases.

2145 COUNTRY CLUB RD, Jacksonville, NC 28546

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 34D2056673

Dermatology Associates Of Coastal Carolina · Jacksonville, NC

Active · expires Mar 26, 2028

CLIA Number34D2056673

Laboratory TypePractitioner Other

Certificate Effective DateMarch 27, 2026

Certificate Expiration DateMarch 26, 2028

Laboratory DirectorScott D. Mcclellan

Laboratory Phone(910) 333-9337

Laboratory LocationDermatology Associates Of Coastal Carolina2145 Country Club Rd, Suite 100, Jacksonville, NC 28546

CLIA data matches this NPI record on: Address Name

This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. SEAN P SCULLY MD

Orthopaedic Surgery