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General NPI Number Information
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NPI Number | 1659115145
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Entity Type | Organization
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Legal Business Name | EXPERIENCE DERMATOLOGY LLC
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Dates
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Enumeration Date | 06/20/2024
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Last Update Date | 06/20/2024
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Provider Practice Location Address
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Address Line | 17 EXECUTIVE PARK DR NE STE 115
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City | ATLANTA
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State | GA
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Zip | 30329-2222
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Country | US
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Telephone | 404-737-2333
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Fax | 404-737-2444
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Provider Business Mailing Address
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Address Line | 17 EXECUTIVE PARK DR NE STE 115
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City | ATLANTA
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State | GA
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Zip | 30329-2222
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Country | US
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Telephone | 404-737-2333
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Fax | 404-737-2444
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. ZACHARY WARREN EYRE
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Credential | MD, MBA
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Telephone | 801-822-8565
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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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