Organization
GEORGIA MOUNTAIN DERMATOLOGY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARLTON TRENT FAULK SR. M.D. (PRESIDENT)
(706) 253-3376
Entity
Organization
Contact information
Practice address
150 INTERSTATE SOUTH DRIVE, SUITE 100, JASPER, GA 30143
(706) 253-3376
Mailing address
150 INTERSTATE SOUTH DRIVE, SUITE 100, JASPER, GA 30143
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
033322
GA
Other
Enumeration date
07/26/2007
Last updated
07/26/2007
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