Healthcare Provider Details

I. General information

NPI: 1710924881
Provider Name (Legal Business Name): GEORGIA DERMASURGERY CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 BELLEVUE RD 16 ERIN OFFICE PARK
DUBLIN GA
31021-2885
US

IV. Provider business mailing address

2400 BELLEVUE RD STE 21A
DUBLIN GA
31021-2890
US

V. Phone/Fax

Practice location:
  • Phone: 478-275-2694
  • Fax: 478-275-2484
Mailing address:
  • Phone: 478-328-1433
  • Fax: 478-922-7939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number087-215
License Number StateGA

VIII. Authorized Official

Name: DR. MICHAEL J SHARKEY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 478-275-2694