Organization
SOUTHERN DERMATOLOGY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WINFRED DERRICK MOODY M.D. (OWNER)
(770) 817-2592
Entity
Organization
Contact information
Practice address
1805 HERRINGTON RD, BUILDING 3, SUITE A, LAWRENCEVILLE, GA 30043-7987
(770) 817-2592
(678) 377-8167
Mailing address
1805 HERRINGTON RD, BUILDING 3, SUITE A, LAWRENCEVILLE, GA 30043-7987
(770) 817-2592
(678) 377-8167
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
045299
GA
Other
Enumeration date
08/02/2011
Last updated
09/28/2011
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