Organization
THE DERMATOLOGY CLINIC OF ST TAMMANY II, LLC
Active
Organization
THE DERMATOLOGY CLINIC OF ST TAMMANY II, LLC
Active
Other names
Grieshaber Dermatology
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EMILY KATHERINE GRIESHABER MD (MANAGER)
(985) 893-1035
Entity
Organization
Contact information
Practice address
714 W 16TH AVE, COVINGTON, LA 70433-2422
(985) 893-1035
(985) 893-1058
Mailing address
714 W 16TH AVE, COVINGTON, LA 70433-2422
(985) 893-1035
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
08440 52 06
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1054810
—
LA
Enumeration date
10/17/2006
Last updated
12/05/2019
Update your record
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