Organization
ESTHETICS CENTER FOR DERMATOLOGY PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PEGGY A. FULLER M.D. (OWNER)
(704) 370-2700
Entity
Organization
Contact information
Practice address
353 CLEMENT AVE, CHARLOTTE, NC 28204-2431
(704) 370-2700
(704) 370-2702
Mailing address
353 CLEMENT AVE, CHARLOTTE, NC 28204-2431
(704) 370-2700
(704) 370-2702
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
127728
NC
Other
Enumeration date
10/25/2006
Last updated
08/22/2020
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