NORTHSIDE DERMATOLOGY ASSOCIATES P.C. NPI 1508047846

NPI Information

NORTHSIDE DERMATOLOGY ASSOCIATES, P.C. is a specialist in Atlanta, GA. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. NORTHSIDE DERMATOLOGY ASSOCIATES, P.C. NPI is 1508047846. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

755 MOUNT VERNON HWY
SUITE 110
ATLANTA, GA
ZIP 30328-274
Phone: (404) 256-9692
Fax: (404) 256-9404

The provider's authorized official is Stewart E Wiegand .
The authorized official title is Doctor/owner and has the following contact phone number (404) 256-5611.

The CLIA number assigned to this NPI record is 11D2290307 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/15/2007 and was last updated on 12/5/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

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