Organization
SUMMIT DERMATOLOGY & LASER CENTER, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAWRENCE GEORGE BLASIK JR. M.D. (OWNER)
(912) 262-1801
Entity
Organization
Contact information
Practice address
1111 GLYNCO PKWY, BLDG 1, SUITE 20, BRUNSWICK, GA 31525-7921
(912) 262-1801
(912) 264-6262
Mailing address
1111 GLYNCO PKWY, BLDG 1, SUITE 20, BRUNSWICK, GA 31525-7921
(912) 262-1801
(912) 264-6262
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
055102
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DB9882
RR MEDICARE
GA
Enumeration date
12/20/2006
Last updated
04/16/2008
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