Provider Demographics
NPI:1497077044
Name:BUCKHEAD MOHS SURGICAL CENTER LLC
Entity Type:Organization
Organization Name:BUCKHEAD MOHS SURGICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KATARINA
Authorized Official - Middle Name:G
Authorized Official - Last Name:LEQUEUX-NALOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH, FAAD
Authorized Official - Phone:404-446-3200
Mailing Address - Street 1:3525 PIEDMONT RD NE
Mailing Address - Street 2:BUILDING 6, SUITE 220
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1578
Mailing Address - Country:US
Mailing Address - Phone:404-446-3200
Mailing Address - Fax:404-446-3201
Practice Address - Street 1:3525 PIEDMONT RD NE
Practice Address - Street 2:BUILDING 6, SUITE 220
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-1578
Practice Address - Country:US
Practice Address - Phone:404-446-3200
Practice Address - Fax:404-446-3201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-24
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical