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General NPI Number Information
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NPI Number | 1265205488
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Entity Type | Organization
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Legal Business Name | SKIN CANCER CENTER OF NORTH GEORGIA PC
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Dates
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Enumeration Date | 10/31/2023
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Last Update Date | 11/09/2023
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Provider Practice Location Address
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Address Line | 405 FANNIN INDUSTRIAL PARK
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City | BLUE RIDGE
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State | GA
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Zip | 30513-4191
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Country | US
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Telephone | 352-259-6553
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Fax |
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Provider Business Mailing Address
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Address Line | 10973 SE 175TH PL STE 100
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City | SUMMERFIELD
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State | FL
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Zip | 34491-0905
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Country | US
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Telephone | 352-259-6553
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Fax | 352-873-9397
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARY BARBER
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Credential | MD
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Telephone | 352-259-6553
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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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Taxonomy #2
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number |
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License Number State |
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