Organization
PREMIERE DERMATOLOGY AND SURGERY, LLC
Active
Other names
Premere Dermatology and Surgery, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
PAUL BOUTTE SR. (PRACTICE MANAGER)
(404) 218-9671
Entity
Organization
Contact information
Practice address
4650 STONE MOUNTAIN HWY, LILBURN, GA 30047
(678) 344-2450
(678) 344-2501
Mailing address
4650 STONE MOUNTAIN HWY, LILBURN, GA 30047
(678) 344-2450
(678) 344-2501
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
39318
GA
Other
Enumeration date
06/27/2007
Last updated
06/17/2015
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