Healthcare Provider Details

I. General information

NPI: 1235065590
Provider Name (Legal Business Name): WEST GEORGIA DERM SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 DIXIE ST
CARROLLTON GA
30117-3816
US

IV. Provider business mailing address

601 DIXIE ST
CARROLLTON GA
30117-3816
US

V. Phone/Fax

Practice location:
  • Phone: 770-838-9333
  • Fax: 770-838-7755
Mailing address:
  • Phone: 770-838-9333
  • Fax: 770-838-7755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SARAH WILSON
Title or Position: MANAGING DIRECTOR
Credential: MD
Phone: 770-838-9333