Provider Demographics
NPI:1376584268
Name:ATLANTA DERMATOLOGY, VEIN & RESEARCH CENTER, LLC
Entity Type:Organization
Organization Name:ATLANTA DERMATOLOGY, VEIN & RESEARCH CENTER, LLC
Other - Org Name:HAMILTON DERMATOLOGY, DBA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANI
Authorized Official - Middle Name:K
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-360-8881
Mailing Address - Street 1:11800 ATLANTIS PL
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-1160
Mailing Address - Country:US
Mailing Address - Phone:770-360-8881
Mailing Address - Fax:770-255-2533
Practice Address - Street 1:11800 ATLANTIS PL
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-1160
Practice Address - Country:US
Practice Address - Phone:770-360-8881
Practice Address - Fax:770-255-2533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4866Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER