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1427040799

NPI Code Detail

MEDICARE: NORTH ATLANTA DERMATOLOGY

MEDICARE: NORTH ATLANTA DERMATOLOGY

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	2004000225	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	11D1050070	OTHER	GA	CLIA ADDL LOCATION
5	11D0973833	OTHER	GA	CLIA #

General Provider Information

NPI Number	:	1427040799
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH ATLANTA DERMATOLOGY

Provider Business Mailing Address
First Line	:	3850 PLEASANT HILL RD
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-4807
Country	:	US
Telephone Number	:	770-814-8222
Fax Number	:

Provider Business Practice Location Address
First Line	:	3850 PLEASANT HILL RD
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-4807
Country	:	US
Telephone Number	:	770-814-8222
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	LAURA J HERNANDEZ
Credential	:
Telephone Number	:	813-493-5252

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	07/03/2023

Similar Medicare Providers

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Practice Location Address:

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1003808361 — CHARLES JACOB DOUCHY M.D.
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1134111495 — GABRIELLE MARIE SABINI M.D.
Practice Location Address:

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30096-4807

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Practice Location Address:

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30096-4807

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1538235114 — MRS. JOAN MARY GARRAMONE NURSE PRACTITIONER
Practice Location Address:

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Practice Location Address:

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Directions to “NORTH ATLANTA DERMATOLOGY ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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