Organization
DAEC, INC
Active
Other names
Dermatology Affiliates East Cobb
Organization subpart
No
Provider details
NPI number
Authorized official
VIRGINIA RUTLEDGE FORNEY M.D. (PRESIDENT/OWNER)
(404) 816-7900
Entity
Organization
Contact information
Practice address
4939 LOWER ROSWELL RD, SUITE 104A, MARIETTA, GA 30068-4338
(404) 816-7900
(404) 816-7929
Mailing address
PO BOX 52226, ATLANTA, GA 30355-0226
(404) 816-7900
(404) 816-7929
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
207N00000X
Dermatology Physician
Primary
—
—
207NS0135X
Procedural Dermatology Physician
—
—
Other
Enumeration date
07/06/2012
Last updated
07/06/2012
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