MEDICARE: AXIS DERMATOLOGY LLC

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	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1194658427
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AXIS DERMATOLOGY LLC

Provider Business Mailing Address
First Line	:	6460 SPALDING DR STE A
Second Line	:
City	:	PEACHTREE CORNERS
State	:	GA
Zip	:	30092-1805
Country	:	US
Telephone Number	:	678-890-8035
Fax Number	:	678-487-5311

Provider Business Practice Location Address
First Line	:	6460 SPALDING DR STE A
Second Line	:
City	:	PEACHTREE CORNERS
State	:	GA
Zip	:	30092-1805
Country	:	US
Telephone Number	:	678-890-8035
Fax Number	:	678-487-5311

Authorized Official
Title or Position	:	CHIEF MEDICAL OFFICER
Name	:	DR. HASAN KHOSRAVI
Credential	:	MD, FAAD
Telephone Number	:	678-779-0332

Provider Enumeration Date	:	06/05/2026
Last Update Date	:	06/05/2026

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Directions to “AXIS DERMATOLOGY LLC ” Practice Location

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