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General NPI Number Information
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NPI Number | 1942929062
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Entity Type | Organization
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Legal Business Name | METRODERM, P.C.
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Dates
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Enumeration Date | 08/23/2022
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 974 S ENOTA DR NE
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City | GAINESVILLE
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State | GA
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Zip | 30501-2429
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Country | US
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Telephone | 770-536-7546
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Fax |
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Provider Business Mailing Address
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Address Line | 875 JOHNSON FY RD NE STE 300
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City | ATLANTA
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State | GA
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Zip | 30342-1418
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Country | US
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Telephone | 678-904-2359
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF REVENUE
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Name | CARRIE WILLIAMS
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Credential |
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Telephone | 678-904-2359
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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 |
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License Number State |
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