Healthcare Provider Details

I. General information

NPI: 1275448748
Provider Name (Legal Business Name): SKIN M.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2140 ROCKBRIDGE RD SW STE 108
STONE MOUNTAIN GA
30087
US

IV. Provider business mailing address

2140 ROCKBRIDGE RD SW STE 108
STONE MOUNTAIN GA
30087
US

V. Phone/Fax

Practice location:
  • Phone: 404-620-0083
  • Fax:
Mailing address:
  • Phone: 404-620-0083
  • Fax: 770-676-0889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: VEVECA COX
Title or Position: CFO
Credential:
Phone: 219-588-0970