Healthcare Provider Details

I. General information

NPI: 1235160060
Provider Name (Legal Business Name): BRIAN P POLLACK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 CLIFTON RD NE
ATLANTA GA
30322-1013
US

IV. Provider business mailing address

1365 CLIFTON RD NE
ATLANTA GA
30322-1013
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-7402
  • Fax: 404-778-4819
Mailing address:
  • Phone: 404-778-7402
  • Fax: 404-778-4819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number052210
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: