Organization
BAUCOM & MINA DERM SURGERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY ALICE MINA M.D. (OWNER)
(404) 844-0496
Entity
Organization
Contact information
Practice address
5555 PEACHTREE DUNWOODY RD, SUITE 206, ATLANTA, GA 30342-1703
(404) 844-0496
(404) 844-0499
Mailing address
5555 PEACHTREE DUNWOODY RD, SUITE 206, ATLANTA, GA 30342-1703
Taxonomy
Speciality
Code
Description
License number
State
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
—
GA
Other
Enumeration date
10/06/2016
Last updated
12/13/2023
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