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General NPI Number Information
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NPI Number | 1437498185
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Entity Type | Organization
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Legal Business Name | NORTHEAST GEORGIA DERMATOLOGY, PC
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Dates
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Enumeration Date | 01/31/2013
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Last Update Date | 01/31/2013
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Provider Practice Location Address
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Address Line | 204 GAINESVILLE HWY
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City | BLAIRSVILLE
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State | GA
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Zip | 30512-4512
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Country | US
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Telephone | 706-781-1600
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Fax | 706-835-2794
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Provider Business Mailing Address
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Address Line | 204 GAINESVILLE HWY
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City | BLAIRSVILLE
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State | GA
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Zip | 30512-4512
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Country | US
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Telephone | 706-781-1600
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Fax | 706-835-2794
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Authorized Official
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Title or Position | OWNER
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Name | DR. PERRY J SCALLAN SR.
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Credential | M.D. F.A.C.P.
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Telephone | 706-781-1600
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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 | 033190
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License Number State | GA
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