# AUGUSTA CENTRE FOR DERMATOLOGY & SKIN RENEWAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255702940
- **Authorized official:** MRS. ANNE M LOEBL MD (OWNER)
- **Authorized official phone:** (706) 447-3909

## Contact information

- **Practice address:** 3614 J DEWEY GRAY CIR, STE B, AUGUSTA, GA 30909-6602
- **Practice address phone:** (706) 447-3909
- **Mailing address:** 3614 J DEWEY GRAY CIR, STE B, AUGUSTA, GA 30909-6602
- **Mailing address phone:** (706) 447-3909

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 022436 | GA | Yes |

## Other

- **Enumeration date:** 10/07/2015
- **Last updated:** 10/07/2015