Organization
NORTHWEST GEORGIA DERMATOLOGY & SKIN SURGERY CENTER PC
Active
Organization
NORTHWEST GEORGIA DERMATOLOGY & SKIN SURGERY CENTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON L SMITH M.D. (OWNER/PRESIDENT)
(706) 235-7711
Entity
Organization
Contact information
Practice address
103 JOHN MADDOX DR NW, ROME, GA 30165-1419
(706) 235-7711
(706) 235-9944
Mailing address
103 JOHN MADDOX DR NW, ROME, GA 30165-1419
(706) 235-7711
(706) 235-9944
Taxonomy
Speciality
Code
Description
License number
State
207NS0135X
Procedural Dermatology Physician
Primary
032302
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000398384A
—
GA
Enumeration date
10/16/2007
Last updated
10/19/2011
Update your record
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