Healthcare Provider Details

I. General information

NPI: 1245902790
Provider Name (Legal Business Name): COURTNEY ANN PRESTWOOD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 CLIFTON RD NE FL 3
ATLANTA GA
30322-4200
US

IV. Provider business mailing address

1525 CLIFTON RD NE FL 3
ATLANTA GA
30322-4200
US

V. Phone/Fax

Practice location:
  • Phone: 318-525-7288
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number111857
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: