Type 2 · Organization ✓ Active NPI ✓ Valid NPI checksum

Adult & Pediatric Dermatology of Tullahoma PC

Dermatology Physician in Tullahoma, TN · enumerated 2006 · authorized official Ken Takegami, President.

Data current as of Jul 13, 2026 · sourced from CMS NPPES

National Provider Identifier

1881658243

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Registry record

Entity type Organization (Type 2)

Legal business name Adult & Pediatric Dermatology of Tullahoma PC

Practice address 100 William Northern Blvd, Ste C, Tullahoma, TN, 37388

Phone (931) 455-7400

Fax (931) 455-6344

Enumeration date Apr 13, 2006

Last updated in NPPES Dec 3, 2009

Taxonomy & classification

207N00000X Dermatology Physician Allopathic & Osteopathic Physicians · License MD0000021099 (TN) Primary

207ND0101X MOHS-Micrographic Surgery Physician Allopathic & Osteopathic Physicians · License MD0000021099 (TN) Secondary

207ND0900X Dermatopathology Physician Allopathic & Osteopathic Physicians · License MD0000021099 (TN) Secondary

Authorized official

Name Ken Takegami

Title President

Phone (931) 455-7400

Other identifiers

Identifier	Type	State	Issuer
3373903	Medicaid	TN	-

What is an NPI number?

A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes, even if the provider moves or changes specialty.

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Frequently asked questions

Who is the authorized official for Adult & Pediatric Dermatology of Tullahoma PC?

NPPES lists Ken Takegami (President) as the authorized official for this organization.

What is the NPI number for Adult & Pediatric Dermatology of Tullahoma PC?

The NPI for Adult & Pediatric Dermatology of Tullahoma PC is 1881658243, a Type 2 (organization) record in the CMS NPPES registry.

Providers at this address

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Mark Blair Surgery Physician · Tullahoma, TN NPI 1508869561 Mark Blair MD PC Surgery Physician · Tullahoma, TN NPI 1972590172 Donald Tucker Internal Medicine Physician · Tullahoma, TN NPI 1487695904 John Patsimas Family Medicine Physician · Tullahoma, TN NPI 1649376849 Susan Warner-Oberwortmann Nurse Practitioner · Tullahoma, TN NPI 1528164688 Ken Takegami Dermatology Physician · Tullahoma, TN NPI 1932251873 John D Patsimas MD Family Medicine Physician · Tullahoma, TN NPI 1235304213 Olan B Kemp Family Medicine Physician · Tullahoma, TN NPI 1881869865

Source: CMS NPPES (public data). Snapshot 2026-07-13. Provider record last updated 2009-12-03.