Organization
COASTAL MEDICAL DERMATOLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANDRA V DAREUS (OWNER)
(215) 439-9519
Entity
Organization
Contact information
Practice address
285 W WIEUCA RD NE, ATLANTA, GA 30342-3321
(215) 439-9519
(678) 647-6762
Mailing address
45 BOYNTON AVE SE UNIT 1207, ATLANTA, GA 30315-1868
(215) 439-9519
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
09/20/2023
Last updated
09/20/2023
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