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General NPI Number Information
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NPI Number | 1295721512
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Entity Type | Organization
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Legal Business Name | ALBANY DERMATOLOGY CLINIC, PA
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Dates
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Enumeration Date | 09/22/2005
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Last Update Date | 04/12/2016
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Provider Practice Location Address
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Address Line | 2709 MEREDYTH DR SUITE 340
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City | ALBANY
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State | GA
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Zip | 31707-0222
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Country | US
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Telephone | 229-883-1130
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Fax | 229-883-1153
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Provider Business Mailing Address
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Address Line | 151 SOUTHHALL LANE SUITE 300
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City | MAITLAND
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State | FL
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Zip | 32751-7172
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Country | US
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Telephone | 407-875-2080
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Fax | 407-650-3455
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MELINDA F. GREENFIELD
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Credential | DO
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Telephone | 407-875-2080
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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 | 049451
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License Number State | GA
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