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General NPI Number Information
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NPI Number | 1194658427
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Entity Type | Organization
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Legal Business Name | AXIS DERMATOLOGY LLC
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Dates
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Enumeration Date | 06/05/2026
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Last Update Date | 06/05/2026
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Provider Practice Location Address
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Address Line | 6460 SPALDING DR STE A
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City | PEACHTREE CORNERS
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State | GA
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Zip | 30092-1805
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Country | US
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Telephone | 678-890-8035
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Fax | 678-487-5311
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Provider Business Mailing Address
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Address Line | 6460 SPALDING DR STE A
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City | PEACHTREE CORNERS
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State | GA
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Zip | 30092-1805
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Country | US
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Telephone | 678-890-8035
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Fax | 678-487-5311
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | DR. HASAN KHOSRAVI
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Credential | MD, FAAD
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Telephone | 678-779-0332
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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 |
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License Number State |
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