Healthcare Provider Details

I. General information

NPI: 1376605394
Provider Name (Legal Business Name): SKIN CANCER & COSMETIC DERMATOLOGY CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 MEMORIAL DR STE 201
DALTON GA
30720-8662
US

IV. Provider business mailing address

136 BATTLEFIELD CROSSING CT
RINGGOLD GA
30736-5176
US

V. Phone/Fax

Practice location:
  • Phone: 706-277-7311
  • Fax: 706-272-3512
Mailing address:
  • Phone: 706-277-7311
  • Fax: 706-529-7210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. KELLEY FINNELL
Title or Position: COO
Credential:
Phone: 423-521-1100