Organization
ADVANCED DERMATOLOGY OF GEORGIA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY DECLUE (DIRECTOR OF PROVIDER SERVICES)
(407) 875-2080
Entity
Organization
Contact information
Practice address
401 W 4TH AVE, ALBANY, GA 31701-1915
(229) 883-1130
(229) 883-1153
Mailing address
151 SOUTHHALL LN, SUITE 300, MAITLAND, FL 32751-7176
(407) 875-2080
(407) 650-3455
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
06/16/2015
Last updated
01/22/2018
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