MEDICARE: ATLANTA DERMATOLOGY & AESTHETICS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	059337	GA

General Provider Information

NPI Number	:	1154712958
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTA DERMATOLOGY & AESTHETICS PC

Provider Business Mailing Address
First Line	:	PO BOX 79343
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30357-7343
Country	:	US
Telephone Number	:	404-873-1795
Fax Number	:

Provider Business Practice Location Address
First Line	:	232 19TH ST NW
Second Line	:	SUITE 7230
City	:	ATLANTA
State	:	GA
Zip	:	30363-1130
Country	:	US
Telephone Number	:	404-873-1795
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN OWNER
Name	:	DR. SUMAYAH TALIAFERRO
Credential	:	MD
Telephone Number	:	404-873-1795

Provider Enumeration Date	:	02/15/2015
Last Update Date	:	02/16/2015

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