Provider Demographics
NPI:1821683616
Name:SPECTRUM DERMATOLOGY OF ATLANTA
Entity Type:Organization
Organization Name:SPECTRUM DERMATOLOGY OF ATLANTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MURAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:470-731-8009
Mailing Address - Street 1:1725 WINDWARD CONCOURSE STE 120
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-3971
Mailing Address - Country:US
Mailing Address - Phone:470-731-8010
Mailing Address - Fax:470-731-8005
Practice Address - Street 1:1725 WINDWARD CONCOURSE STE 120
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3971
Practice Address - Country:US
Practice Address - Phone:470-731-8010
Practice Address - Fax:470-731-8005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-04
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty