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General NPI Number Information
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NPI Number | 1447851357
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY AND SURGERY SPECIALISTS OF NORTH ATLANTA PC
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Dates
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Enumeration Date | 11/06/2020
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Last Update Date | 11/06/2020
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Provider Practice Location Address
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Address Line | 4800 OLDE TOWNE PKWY STE 250
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City | MARIETTA
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State | GA
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Zip | 30068-4428
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Country | US
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Telephone | 770-971-3376
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Fax | 770-578-8567
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Provider Business Mailing Address
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Address Line | 4800 OLDE TOWNE PKWY STE 250
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City | MARIETTA
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State | GA
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Zip | 30068-4428
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Country | US
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Telephone | 770-971-3376
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Fax | 770-578-8567
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Authorized Official
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Title or Position | MD
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Name | ONAOPEMIPO OFODILE
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Credential |
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Telephone | 770-971-3376
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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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