Organization
DERMATOLOGY CENTER OF ATLANTA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LESLIE C GRAY MD (OWNER)
(770) 497-0699
Entity
Organization
Contact information
Practice address
9900 MEDLOCK BRIDGE RD, DULUTH, GA 30097-2017
(770) 497-0699
(770) 497-0388
Mailing address
9900 MEDLOCK BRIDGE RD, DULUTH, GA 30097-2017
(770) 497-0699
(770) 497-0388
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
040083
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CK6511
RAILROAD MEDICARE GROUP
GA
Enumeration date
11/21/2006
Last updated
06/13/2019
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