Organization · NPI-2
Georgia Dermatology & Skin Cancer Center, LLC
Dermatology · Dublin, GA
NPI number1063460459
StatusActive
Last updated in NPPESOct 30, 2007
Details
- NPI
- 1063460459
- Entity type
- Organization (NPI-2)
- Legal business name
- Georgia Dermatology & Skin Cancer Center, LLC
- Organization subpart
- No
- Enumeration date
- May 5, 2006
- Last updated
- Oct 30, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207N00000X | Dermatology | – | – | Yes |
| 207ZD0900X | Pathology, Dermatopathology | – | – | |
| 207ND0101X | Dermatology, MOHS-Micrographic Surgery | – | – | |
| 207NS0135X | Dermatology, Procedural Dermatology | – | – | |
| 207ND0900X | Dermatology, Dermatopathology | – | – | |
| 207NP0225X | Dermatology, Pediatric Dermatology | – | – | |
| 207NI0002X | Dermatology, Clinical & Laboratory Dermatological Immunology | – | – |
Other names
- Georgia Dermatology & Skin Care Center (Other Name)
Practice location
2400 Bellevue Rd16 Erin Office Park
Dublin, GA 31021-2885
Phone 478-328-0281 · Fax 478-328-0438
Mailing address
2400 Bellevue Rd Ste 21aDublin, GA 31021-2890
Phone 478-328-0281 · Fax 478-328-0438
Authorized official
Michael J Sharkey
Owner
4782752694
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