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Organization

NORTH ATLANTA DERMATOLOGY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LAURA J HERNANDEZ (CREDENTIALING SPECIALIST)
(813) 493-5252
Entity
Organization

Contact information

Practice address
3850 PLEASANT HILL RD, DULUTH, GA 30096-4807
(770) 814-8222
Mailing address
3850 PLEASANT HILL RD, DULUTH, GA 30096-4807
(770) 814-8222

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
2004000225
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
11D0973833
CLIA #
GA
01
11D1050070
CLIA ADDL LOCATION
GA
05
300033599A
GA
05
300033599B
GA
05
55003258A
GA
Enumeration date
08/22/2005
Last updated
07/03/2023
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