MEDICARE: DERMATOLOGY AND SKIN CANCER CENTER OF AUGUSTA, P.C.

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

General Provider Information

NPI Number	:	1912991902
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DERMATOLOGY AND SKIN CANCER CENTER OF AUGUSTA, P.C.

Provider Business Mailing Address
First Line	:	1248 AUGUSTA WEST PKWY
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-1854
Country	:	US
Telephone Number	:	706-863-0500
Fax Number	:

Provider Business Practice Location Address
First Line	:	1248 AUGUSTA WEST PKWY
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-1854
Country	:	US
Telephone Number	:	706-863-0500
Fax Number	:

Authorized Official
Title or Position	:	INCURANCE COORDINATOR
Name	:	MISS LINDSEY KRISTEN CORLEY
Credential	:
Telephone Number	:	706-863-0500

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	12/23/2015

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