Healthcare Provider Details

I. General information

NPI: 1821157116
Provider Name (Legal Business Name): DERMATOLOGY ASSOCIATES NE GA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

974 SOUTH ENOTA DRIVE NE
GAINESVILLE GA
30501
US

IV. Provider business mailing address

974 SOUTH ENOTA DRIVE NE
GAINESVILLE GA
30501
US

V. Phone/Fax

Practice location:
  • Phone: 770-536-7546
  • Fax: 678-343-2006
Mailing address:
  • Phone: 770-536-7546
  • Fax: 678-343-2006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DANIEL C RABB
Title or Position: PHYSICIAN
Credential: MD
Phone: 770-536-7546