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General NPI Number Information
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NPI Number | 1568533180
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Entity Type | Organization
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Legal Business Name | ATLANTA CENTER OF DERMATOLOGY AND MEDISPA PC
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 03/08/2013
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Provider Practice Location Address
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Address Line | 2950 STONE HOGAN CONNECTOR BUILDING 4
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City | ATLANTA
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State | GA
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Zip | 30331-2837
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Country | US
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Telephone | 404-349-7440
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Fax | 404-349-7402
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Provider Business Mailing Address
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Address Line | 2950 STONE HOGAN CONNECTOR BUILDING 4
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City | ATLANTA
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State | GA
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Zip | 30331-2837
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Country | US
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Telephone | 404-349-7440
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Fax | 404-349-7402
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Authorized Official
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Title or Position | DERMATOLOGIST PRESIDENT
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Name | GLORIA CAMPBELL D HUE
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Credential | MD
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Telephone | 404-349-7440
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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 | 024412
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License Number State | GA
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