Provider Demographics
NPI:1558380527
Name:GEORGIA DERMATOLOGY SPECIALISTS PC
Entity Type:Organization
Organization Name:GEORGIA DERMATOLOGY SPECIALISTS PC
Other - Org Name:OLANSKY DERMATOLOGY ASSOCIATES,PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:OLANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-355-5484
Mailing Address - Street 1:3379 PEACHTREE RD NE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-1031
Mailing Address - Country:US
Mailing Address - Phone:404-355-5484
Mailing Address - Fax:404-355-5787
Practice Address - Street 1:3379 PEACHTREE RD NE
Practice Address - Street 2:SUITE 500
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30326-1031
Practice Address - Country:US
Practice Address - Phone:404-355-5484
Practice Address - Fax:404-355-5787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA17440000X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACA0620Medicare UPIN