Provider Demographics
NPI:1235358441
Name:KAYAL DERMATOLOGY & SKIN CANCER SPECIALISTS
Entity Type:Organization
Organization Name:KAYAL DERMATOLOGY & SKIN CANCER SPECIALISTS
Other - Org Name:KAYAL DERMATOLOGY AND SKIN CANCER SPECIALISTS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:SEATON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-426-7177
Mailing Address - Street 1:141 LACY ST NW STE 200
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1118
Mailing Address - Country:US
Mailing Address - Phone:770-426-7177
Mailing Address - Fax:770-426-7745
Practice Address - Street 1:141 LACY ST NW STE 200
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1118
Practice Address - Country:US
Practice Address - Phone:770-426-7177
Practice Address - Fax:770-426-7745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042306174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6065Medicare ID - Type Unspecified
GAG54509Medicare UPIN