Healthcare Provider Details

I. General information

NPI: 1538396577
Provider Name (Legal Business Name): CENTER FOR DERMATOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2009
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 WELLNESS WAY STE 210
LAWRENCEVILLE GA
30046-3304
US

IV. Provider business mailing address

721 WELLNESS WAY STE 210
LAWRENCEVILLE GA
30046-3304
US

V. Phone/Fax

Practice location:
  • Phone: 770-682-2500
  • Fax: 770-682-2014
Mailing address:
  • Phone: 770-682-2500
  • Fax: 770-682-2014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number047327
License Number StateGA

VIII. Authorized Official

Name: DR. ABDUL HAFEEZ
Title or Position: MANAGING MEMBER
Credential: M.D.
Phone: 678-476-5228