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General NPI Number Information
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NPI Number | 1417910431
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Entity Type | Organization
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Legal Business Name | ATLANTA CENTER FOR DERMATOLOGIC DISEASES PC
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Dates
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Enumeration Date | 04/10/2006
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Last Update Date | 12/17/2012
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Provider Practice Location Address
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Address Line | 1265 UPPER HEMBREE RD STE 100
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City | ROSWELL
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State | GA
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Zip | 30076-1143
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Country | US
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Telephone | 770-751-1433
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Fax | 770-751-7410
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Provider Business Mailing Address
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Address Line | 1265 UPPER HEMBREE RD STE 100
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City | ROSWELL
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State | GA
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Zip | 30076-1143
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Country | US
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Telephone | 770-751-1433
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Fax | 770-751-7410
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Authorized Official
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Title or Position | BOOKKEEPING INSURANCE
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Name | MS. ANITA REINER
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Credential |
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Telephone | 770-751-1433
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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 | 027080
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 034135
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 044141
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License Number State | GA
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Taxonomy #4
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 032377
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License Number State | GA
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Taxonomy #5
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 032990
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License Number State | GA
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