MEDICARE: COLE DERMATOLOGY & AESTHETIC CENTER, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207NS0135X	Procedural Dermatology Physician	030406	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114100377
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLE DERMATOLOGY & AESTHETIC CENTER, P.C.

Provider Business Mailing Address
First Line	:	3655 HOWELL FERRY RD
Second Line	:	STE 400
City	:	DULUTH
State	:	GA
Zip	:	30096-3186
Country	:	US
Telephone Number	:	678-417-6900
Fax Number	:

Provider Business Practice Location Address
First Line	:	3655 HOWELL FERRY RD
Second Line	:	STE 400
City	:	DULUTH
State	:	GA
Zip	:	30096-3186
Country	:	US
Telephone Number	:	678-417-6900
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KENDRA ANN COLE
Credential	:	M.D.
Telephone Number	:	678-417-6900

Provider Enumeration Date	:	12/11/2007
Last Update Date	:	12/19/2011

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