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General NPI Number Information
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NPI Number | 1154712958
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Entity Type | Organization
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Legal Business Name | ATLANTA DERMATOLOGY & AESTHETICS PC
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Dates
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Enumeration Date | 02/15/2015
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Last Update Date | 02/16/2015
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Provider Practice Location Address
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Address Line | 232 19TH ST NW SUITE 7230
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City | ATLANTA
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State | GA
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Zip | 30363-1130
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Country | US
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Telephone | 404-873-1795
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 79343
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City | ATLANTA
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State | GA
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Zip | 30357-7343
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Country | US
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Telephone | 404-873-1795
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | DR. SUMAYAH TALIAFERRO
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Credential | MD
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Telephone | 404-873-1795
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 059337
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License Number State | GA
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