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General NPI Number Information
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NPI Number | 1710213947
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Entity Type | Organization
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Legal Business Name | DERMATOLOGY & SKIN CANCER PREVENTION CENTER, INC.
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Dates
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Enumeration Date | 10/22/2009
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Last Update Date | 03/23/2011
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Provider Practice Location Address
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Address Line | 1215 EAGLES LANDING PARKWAY SUITE 205
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-7280
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Country | US
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Telephone | 770-389-9116
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Fax | 770-506-4580
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Provider Business Mailing Address
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Address Line | 1215 EAGLES LANDING PARKWAY SUITE 205
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-7280
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Country | US
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Telephone | 770-389-9116
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Fax | 770-506-4580
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Authorized Official
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Title or Position | OWNER
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Name | DAVID S. BRYANT
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Credential | M.D.
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Telephone | 770-389-9116
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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 | 005538
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 052394
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License Number State | GA
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