Healthcare Provider Details

I. General information

NPI: 1942929062
Provider Name (Legal Business Name): METRODERM, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

974 S ENOTA DR NE
GAINESVILLE GA
30501-2429
US

IV. Provider business mailing address

875 JOHNSON FY RD NE STE 300
ATLANTA GA
30342-1418
US

V. Phone/Fax

Practice location:
  • Phone: 770-536-7546
  • Fax:
Mailing address:
  • Phone: 678-904-2359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: CARRIE WILLIAMS
Title or Position: DIRECTOR OF REVENUE
Credential:
Phone: 678-904-2359