MEDICARE: FLOURISH DERMATOLOGY AND AESTHETICS

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	:	1508603606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLOURISH DERMATOLOGY AND AESTHETICS

Provider Business Mailing Address
First Line	:	317 RIGGS PARK PL NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-2580
Country	:	US
Telephone Number	:	614-595-4892
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 SAINT CHARLES AVE STE 101
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70130-4436
Country	:	US
Telephone Number	:	504-434-2319
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DOCTOR/OWNER
Name	:	LAUREN PAYNE
Credential	:	MD
Telephone Number	:	614-595-4892

Provider Enumeration Date	:	07/15/2024
Last Update Date	:	08/07/2024

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