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General NPI Number Information
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NPI Number | 1720506231
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Entity Type | Organization
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Legal Business Name | O'REILLY COMPREHENSIVE DERMATOLOGY, INC.
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Dates
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Enumeration Date | 09/05/2017
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Last Update Date | 08/03/2018
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Provider Practice Location Address
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Address Line | 755 MOUNT VERNON HWY. SUITE 330
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City | ATLANTA
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State | GA
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Zip | 30228
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Country | US
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Telephone | 404-330-8445
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Fax | 404-330-8456
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Provider Business Mailing Address
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Address Line | 1421 WESSYNGTON ROAD
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City | ATLANTA
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State | GA
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Zip | 30306
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Country | US
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Telephone | 404-273-4440
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT/SECRETARY
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Name | MR. JAMES ZWALD
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Credential |
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Telephone | 404-273-4440
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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 | 50418
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License Number State | GA
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