Provider Demographics
NPI:1497072920
Name:SKINPATH SOLUTIONS, INC
Entity Type:Organization
Organization Name:SKINPATH SOLUTIONS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:DIPTI
Authorized Official - Middle Name:
Authorized Official - Last Name:ANAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-737-4575
Mailing Address - Street 1:2000 LAKE PARK DR SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-7611
Mailing Address - Country:US
Mailing Address - Phone:678-556-9411
Mailing Address - Fax:
Practice Address - Street 1:2000 LAKE PARK DR SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-7611
Practice Address - Country:US
Practice Address - Phone:678-556-9411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathologyGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
11D2010733OtherCLIA NUMBER
GA202G696676Medicare PIN
GA202G707953Medicare PIN