Organization
RIVERSIDE DERMATOLOGY AND AESTHETIC CENTER, PC
Active
Organization
RIVERSIDE DERMATOLOGY AND AESTHETIC CENTER, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACQUELINE NICOLE FUSSELL M.D (PHYSICIAN)
(706) 257-4189
Entity
Organization
Contact information
Practice address
2045 CENTRE STONE CT, SUITE B, COLUMBUS, GA 31904-4571
(706) 257-4189
Mailing address
2045 CENTRE STONE CT, SUITE B, COLUMBUS, GA 31904-4571
(706) 257-4189
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
70111
GA
Other
Enumeration date
07/01/2014
Last updated
07/01/2014
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