Provider Demographics
NPI:1073713277
Name:ATLANTA SKIN CANCER SPECIALISTS, P.C.
Entity Type:Organization
Organization Name:ATLANTA SKIN CANCER SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATARINA
Authorized Official - Middle Name:G
Authorized Official - Last Name:LEQUEUX-NALOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-446-3200
Mailing Address - Street 1:3330 PRESTON RIDGE RD STE 280
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4540
Mailing Address - Country:US
Mailing Address - Phone:404-446-3200
Mailing Address - Fax:404-446-3201
Practice Address - Street 1:3330 PRESTON RIDGE RD STE 280
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4540
Practice Address - Country:US
Practice Address - Phone:404-446-3200
Practice Address - Fax:404-446-3201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050005261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH37280Medicare UPIN