Provider Demographics
NPI:1679682561
Name:THE DERM CENTER OF NEWTON
Entity Type:Organization
Organization Name:THE DERM CENTER OF NEWTON
Other - Org Name:JOSEPH OVERTON, M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:VETETO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-788-0620
Mailing Address - Street 1:PO BOX 945934
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30394-5934
Mailing Address - Country:US
Mailing Address - Phone:770-788-0620
Mailing Address - Fax:678-342-3327
Practice Address - Street 1:4155 BAKER ST NE
Practice Address - Street 2:SUITE 100
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-1405
Practice Address - Country:US
Practice Address - Phone:770-788-0620
Practice Address - Fax:678-342-3327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038900207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4497Medicare PIN
GACJ4982Medicare PIN