Provider Demographics
NPI:1437371820
Name:DERMATOLOGY AND AESTHETIC INSTITUTE
Entity Type:Organization
Organization Name:DERMATOLOGY AND AESTHETIC INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:G
Authorized Official - Last Name:NUNNALLY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-769-3376
Mailing Address - Street 1:PO BOX 82429
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70884-2429
Mailing Address - Country:US
Mailing Address - Phone:225-769-3376
Mailing Address - Fax:
Practice Address - Street 1:7330 PERKINS ROAD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4325
Practice Address - Country:US
Practice Address - Phone:225-769-3376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty