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General NPI Number Information
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NPI Number | 1235358441
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Entity Type | Organization
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Legal Business Name | KAYAL DERMATOLOGY & SKIN CANCER SPECIALISTS
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 11/08/2021
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Provider Practice Location Address
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Address Line | 141 LACY ST NW STE 200
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City | MARIETTA
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State | GA
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Zip | 30060-1118
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Country | US
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Telephone | 770-426-7177
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Fax | 770-426-7745
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Provider Business Mailing Address
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Address Line | 141 LACY ST NW STE 200
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City | MARIETTA
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State | GA
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Zip | 30060-1118
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Country | US
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Telephone | 770-426-7177
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Fax | 770-426-7745
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | ROGER SEATON
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Credential |
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Telephone | 770-426-7177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 042306
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License Number State | GA
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