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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