Provider Demographics
NPI:1669642948
Name:THE GEORGIA CENTER FOR DERMATOLOGY AND SKIN CANCER SPECIALISTS
Entity Type:Organization
Organization Name:THE GEORGIA CENTER FOR DERMATOLOGY AND SKIN CANCER SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-364-8876
Mailing Address - Street 1:902 PONDER PLACE CT
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3184
Mailing Address - Country:US
Mailing Address - Phone:706-364-8876
Mailing Address - Fax:706-364-9061
Practice Address - Street 1:902 PONDER PLACE CT
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3184
Practice Address - Country:US
Practice Address - Phone:706-364-8876
Practice Address - Fax:706-364-9061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA059557261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center