Provider Demographics
NPI:1275929267
Name:DOUGLAS DERMATOLOGY AND SKIN CANCER SPECIALISTS LLC
Entity Type:Organization
Organization Name:DOUGLAS DERMATOLOGY AND SKIN CANCER SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FIRAS
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:HOUGEIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-702-3376
Mailing Address - Street 1:151 SOUTHHALL LN
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7176
Mailing Address - Country:US
Mailing Address - Phone:407-875-2080
Mailing Address - Fax:407-650-3455
Practice Address - Street 1:4645 TIMBER RIDGE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-7541
Practice Address - Country:US
Practice Address - Phone:678-702-3376
Practice Address - Fax:678-909-0446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-07
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA102G707563Medicare PIN