Provider Demographics
NPI:1497286223
Name:ALPHARETTA MOHS SURGICAL CENTER
Entity Type:Organization
Organization Name:ALPHARETTA MOHS SURGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/CHAIRMAIN
Authorized Official - Prefix:
Authorized Official - First Name:KATARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEQUEUX-NALOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-446-3200
Mailing Address - Street 1:3330 PRESTON RIDGE RD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4508
Mailing Address - Country:US
Mailing Address - Phone:404-446-3200
Mailing Address - Fax:404-446-3201
Practice Address - Street 1:3330 PRESTON RIDGE RD
Practice Address - Street 2:SUITE 260
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4508
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:2017-03-23
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical