DERMATOLOGY CENTER OF NORTH MS PA
NPI 1053491605
Dermatology in Tupelo, MS

Active since October 17, 2006CLIA Certified · 2 labs
516 PEGRAM DR, TUPELO, MS 38801(662) 844-6272(662) 844-1603 Get Directions Write a Review

NPPES record last updated: March 26, 2015. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dermatology Center Of North Ms Pa NPPES

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

DERMATOLOGY CENTER OF NORTH MS PA (NPI 1053491605) is a healthcare organization registered as a dermatology in Tupelo, Mississippi and active in the NPI registry since October 2006. The organization holds 2 active CLIA laboratory certificates and lists John D Burk, President, as its authorized official.

NPPES Registry Identity

NPI1053491605
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameDERMATOLOGY CENTER OF NORTH MS PA
Location Address516 PEGRAM DRTupelo, MS 38801-6347
Mailing Address516 Pegram DrTupelo, MS 38801-6347 · (662) 844-6272 · Fax (662) 844-1603
Fax(662) 844-1603
Organization SubpartNo
Authorized OfficialJohn D BurkPresident · (662) 844-6272
Enumeration DateOctober 17, 2006
Last NPPES UpdateMarch 26, 2015
NPI 1053491605 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
License Licensed in MS · 7919
Definition
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.
516 PEGRAM DR, Tupelo, MS 38801

Other Identifiers 2

Medicaid9015434MS
Medicare PINC02188MS

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 2

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 25D2221332

Dermatology Center Of North Ms PA · Corinth, MS
Active · expires Jul 19, 2028
CLIA Number25D2221332
Laboratory TypePhysician Office
Certificate Effective DateJuly 20, 2026
Certificate Expiration DateJuly 19, 2028
Laboratory DirectorDr. Bradley Greenhaw
Laboratory Phone(662) 844-6272
Laboratory LocationDermatology Center Of North Ms PA100 Norman, Corinth, MS 38834
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Certificate of Compliance 25D0316884

Dermatology Center Of North Ms PA · Tupelo, MS
Active · expires Aug 8, 2026
CLIA Number25D0316884
Laboratory TypePhysician Office
Certificate Effective DateAugust 9, 2024
Certificate Expiration DateAugust 8, 2026
Laboratory DirectorBradley N. Greenhaw
Laboratory Phone(662) 844-6272
Laboratory LocationDermatology Center Of North Ms PA340 Court Street, Tupelo, MS 38804
CLIA data matches this NPI record on: Name Phone
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 4

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

Dermatology
516 PEGRAM DR
TUPELO, MS 38801
Physician Assistant
516 PEGRAM DR
TUPELO, MS 38801
Dermatology
516 PEGRAM DR
TUPELO, MS 38801
Dermatology
516 PEGRAM DR
TUPELO, MS 38801

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Dermatology Center Of North Ms PA's NPI number?

The NPI number for Dermatology Center Of North Ms PA is 1053491605. It was assigned to this organization in the NPPES registry on October 17, 2006.

Where is Dermatology Center Of North Ms PA located?

Dermatology Center Of North Ms PA is located at 516 Pegram Dr, Tupelo, MS 38801. The listed phone number is (662) 844-6272.

What is Dermatology Center Of North Ms PA's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Does Dermatology Center Of North Ms PA hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Dermatology Center Of North Ms PA was last updated on March 26, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.