Provider Demographics
NPI:1477596203
Name:GWINNETT DERMATOLOGY PC D/B/A GEORGIA DERMATOLOGY PARTNERS
Entity Type:Organization
Organization Name:GWINNETT DERMATOLOGY PC D/B/A GEORGIA DERMATOLOGY PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIAL
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-972-4845
Mailing Address - Street 1:2383 PATE ST N
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-3250
Mailing Address - Country:US
Mailing Address - Phone:770-972-4845
Mailing Address - Fax:770-972-0358
Practice Address - Street 1:2383 PATE ST N
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3250
Practice Address - Country:US
Practice Address - Phone:770-972-4845
Practice Address - Fax:770-972-0358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CB2388OtherRAILROAD MCARE
CB2388OtherRAILROAD MCARE