Organization
AESTHETIC DERMATOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ATHENA PHAN M.D. (OWNER)
(334) 273-1122
Entity
Organization
Contact information
Practice address
300 TAYLOR RD, SUITE 800, MONTGOMERY, AL 36117-3521
(334) 273-1122
Mailing address
2257 TAYLOR RD, SUITE 200, MONTGOMERY, AL 36117-7790
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
04/15/2010
Last updated
04/15/2010
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