MEDICARE: GEORGIA DERMATOLOGY SPECIALISTS 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	174400000X	Specialist	17440000X	GA

General Provider Information

NPI Number	:	1558380527
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGIA DERMATOLOGY SPECIALISTS PC

Provider Business Mailing Address
First Line	:	3379 PEACHTREE RD NE
Second Line	:	SUITE 500
City	:	ATLANTA
State	:	GA
Zip	:	30326-1031
Country	:	US
Telephone Number	:	404-355-5484
Fax Number	:	404-355-5787

Provider Business Practice Location Address
First Line	:	3379 PEACHTREE RD NE
Second Line	:	SUITE 500
City	:	ATLANTA
State	:	GA
Zip	:	30326-1031
Country	:	US
Telephone Number	:	404-355-5484
Fax Number	:	404-355-5787

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ALAN J OLANSKY
Credential	:	MD
Telephone Number	:	404-355-5484

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	07/16/2019

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