Healthcare Provider Details

I. General information

NPI: 1497286223
Provider Name (Legal Business Name): ALPHARETTA MOHS SURGICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2017
Last Update Date: 07/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 PRESTON RIDGE RD SUITE 260
ALPHARETTA GA
30005-4508
US

IV. Provider business mailing address

3330 PRESTON RIDGE RD SUITE 260
ALPHARETTA GA
30005-4508
US

V. Phone/Fax

Practice location:
  • Phone: 404-446-3200
  • Fax: 404-446-3201
Mailing address:
  • Phone: 404-446-3200
  • Fax: 404-446-3201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATARINA LEQUEUX-NALOVIC
Title or Position: MEDICAL DIRECTOR/CHAIRMAIN
Credential: M.D.
Phone: 404-446-3200