Organization
DIVINE DERMATOLOGY & AESTHETICS LLC
Active
Organization
DIVINE DERMATOLOGY & AESTHETICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TUNISIA F. CORNELIUS MD (AUTHORIZED OFFICIAL)
(678) 589-7546
Entity
Organization
Contact information
Practice address
1039 GRANT ST SE STE A-11, ATLANTA, GA 30315-2014
(678) 589-7546
(678) 589-7500
Mailing address
830 GLENWOOD AVE SE STE 510-209, ATLANTA, GA 30316-1966
(678) 589-7546
(678) 589-7500
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
GA
Other
Enumeration date
03/15/2018
Last updated
03/15/2018
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