Healthcare Provider Details

I. General information

NPI: 1912991902
Provider Name (Legal Business Name): DERMATOLOGY AND SKIN CANCER CENTER OF AUGUSTA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 12/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1248 AUGUSTA WEST PKWY
AUGUSTA GA
30909-1854
US

IV. Provider business mailing address

1248 AUGUSTA WEST PKWY
AUGUSTA GA
30909-1854
US

V. Phone/Fax

Practice location:
  • Phone: 706-863-0500
  • Fax:
Mailing address:
  • Phone: 706-863-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: MISS LINDSEY KRISTEN CORLEY
Title or Position: INCURANCE COORDINATOR
Credential:
Phone: 706-863-0500