Organization
MODERN DERMATOLOGY ATLANTA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NAGA B MEDURI MD (OWNER)
(423) 280-2594
Entity
Organization
Contact information
Practice address
5696 WHITEHALL WALK, DUNWOODY, GA 30338
(423) 280-2594
Mailing address
5696 WHITEHALL WALK, DUNWOODY, GA 30338-2655
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
57104
GA
Other
Enumeration date
08/11/2017
Last updated
08/11/2017
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