Organization
EPIPHANY DERMATOLOGY OF GEORGIA, LLC
Active
Organization
EPIPHANY DERMATOLOGY OF GEORGIA, LLC
Active
Other names
Epiphany Dermatology
Organization subpart
No
Provider details
NPI number
Authorized official
GHEORGHE PUSTA (EXECUTIVE DIRECTOR)
(512) 628-0465
Entity
Organization
Contact information
Practice address
874 LANIER AVE W STE 270, FAYETTEVILLE, GA 30214-7617
(770) 251-5111
Mailing address
7300 RANCH ROAD 2222, BUILDING 1, STE 200, AUSTIN, TX 78730
(512) 628-0465
(512) 233-2711
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
207NS0135X
Procedural Dermatology Physician
—
—
Other
Enumeration date
08/31/2006
Last updated
03/19/2025
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