Organization
MARIETTA DERMATOLOGY ASSOCIATES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GOBIN COPPA (DIRECTOR OF BILLING OFFICE)
(770) 422-1013
Entity
Organization
Contact information
Practice address
111 MARBLE MILL RD NW, MARIETTA DERMATOLOGY ASSOCIATES PA, MARIETTA, GA 30060-1047
(770) 422-1013
(770) 514-5996
Mailing address
111 MARBLE MILL RD NW, MARIETTA DERMATOLOGY ASSOCIATES PA, MARIETTA, GA 30060-1047
(770) 422-1013
(770) 514-5996
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CM6753
MEDICARE RAILROAD
—
Enumeration date
01/12/2007
Last updated
04/28/2023
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