Healthcare Provider Details

I. General information

NPI: 1093794117
Provider Name (Legal Business Name): EMILY M ALTMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 08/11/2024
Certification Date: 08/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 CLIFTON RD. NE 1ST FLOOR, SUITE 105
ATLANTA GA
30322
US

IV. Provider business mailing address

1525 CLIFTON RD NE STE 1051
ATLANTA GA
30322-4200
US

V. Phone/Fax

Practice location:
  • Phone: 616-717-3082
  • Fax:
Mailing address:
  • Phone: 616-717-3082
  • Fax: 505-272-6228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD2017-0772
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number25MA06877100
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number101139
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: