Organization
ATHENS-OCONEE SKIN CANCER & DERMATOLOGY, LLC
Active
Other names
OCONEE DERMATOPATHOLOGY
Organization subpart
No
Provider details
NPI number
Authorized official
STELLA MARIES BULENGO M.D. (OWNER)
(706) 769-7546
Entity
Organization
Contact information
Practice address
1582 MARS HILL RD, SUITE A, WATKINSVILLE, GA 30677-4836
(706) 769-7546
(706) 769-2443
Mailing address
1582 MARS HILL RD, SUITE A, WATKINSVILLE, GA 30677-4836
(706) 769-7546
(706) 769-2443
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
050931
GA
207ND0900X
Dermatopathology Physician
050931
GA
207NS0135X
Procedural Dermatology Physician
Primary
050931
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050931
LICENSE
GA
01
—
1194717447
NPI INDIVIDUAL
—
Enumeration date
06/11/2007
Last updated
09/11/2025
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