Provider Demographics
NPI:1205833894
Name:METRODERM, P.C.
Entity Type:Organization
Organization Name:METRODERM, P.C.
Other - Org Name:METROPOLITAN DERMATOLOGIC SURGERY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIAMONDIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAPADOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-257-9933
Mailing Address - Street 1:875 JOHNSON FERRY RD NE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1418
Mailing Address - Country:US
Mailing Address - Phone:404-257-9933
Mailing Address - Fax:404-257-9931
Practice Address - Street 1:875 JOHNSON FERRY RD NE
Practice Address - Street 2:SUITE 300
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1418
Practice Address - Country:US
Practice Address - Phone:404-257-9933
Practice Address - Fax:404-257-9931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA22773207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4725Medicare UPIN