MEDICARE: ATLANTA SKIN AND AESTHETICS

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	207NS0135X	Procedural Dermatology Physician

General Provider Information

NPI Number	:	1780872556
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTA SKIN AND AESTHETICS

Provider Business Mailing Address
First Line	:	1100 JOHNSON FERRY RD STE 465
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1709
Country	:	US
Telephone Number	:	404-252-4110
Fax Number	:	404-252-2188

Provider Business Practice Location Address
First Line	:	5671 PEACHTREE DUNWOODY RD STE 660
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-5006
Country	:	US
Telephone Number	:	404-252-4110
Fax Number	:	404-252-2188

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	RICHARD EDGAR NIX JR.
Credential	:
Telephone Number	:	404-252-4110

Provider Enumeration Date	:	10/05/2007
Last Update Date	:	09/25/2024

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