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NPI Code Detail

MEDICARE: COLUMBUS DERMATOLOGY, PC

MEDICARE: COLUMBUS DERMATOLOGY, 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
1261QM2500XMedical Specialty Clinic/Center6696501GA

General Provider Information

NPI Number : 1932280229
Entity Type Code : Organization
Provider Name (Legal Business Name) : COLUMBUS DERMATOLOGY, PC
Provider Business Mailing Address
First Line : 7301 BLACKMON RD
Second Line :
City : COLUMBUS
State : GA
Zip : 31909-4478
Country : US
Telephone Number : 706-568-2700
Fax Number : 706-568-2705
Provider Business Practice Location Address
First Line : 7301 BLACKMON RD
Second Line :
City : COLUMBUS
State : GA
Zip : 31909-4478
Country : US
Telephone Number : 706-568-2700
Fax Number : 706-568-2705
Authorized Official
Title or Position : PRACTICE ADMINISTRATOR
Name : ANNE GAGNE
Credential :
Telephone Number : 706-568-2700
Provider Enumeration Date : 10/17/2006
Last Update Date : 08/22/2020

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Directions to “COLUMBUS DERMATOLOGY, PC ” Practice Location

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