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General NPI Number Information
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NPI Number | 1942780994
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Entity Type | Organization
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Legal Business Name | SKYN CLINIC & APOTHECARY
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Dates
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Enumeration Date | 08/20/2018
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Last Update Date | 08/20/2018
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Provider Practice Location Address
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Address Line | 1150 PEACHTREE INDUSTRIAL BLVD STE 165
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City | SUWANEE
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State | GA
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Zip | 30024-1903
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Country | US
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Telephone | 678-835-8741
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Fax |
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Provider Business Mailing Address
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Address Line | 1148 WOODTRACE LN
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City | AUBURN
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State | GA
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Zip | 30011-4721
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Country | US
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Telephone | 678-447-6597
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. ZOLA NEMORIN
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Credential | ESTHETICIAN
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Telephone | 678-447-6597
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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 | ES004943
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License Number State | GA
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