Organization
STONE MOUNTAIN SKIN HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DORIS LYNN NGUENGUE-SOWA (CREDENTIALING MANAGER)
(404) 293-4163
Entity
Organization
Contact information
Practice address
5430 JIMMY CARTER BLVD, NORCROSS, GA 30093
(770) 508-8241
(770) 558-1324
Mailing address
5430 JIMMY CARTER BLVD, NORCROSS, GA 30093
(770) 508-8241
(770) 558-1324
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
59834
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
142943194A
—
GA
Enumeration date
05/22/2014
Last updated
01/19/2016
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