Provider Demographics
NPI:1972561819
Name:HERSKOWITZ, LOUIS JACK (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:JACK
Last Name:HERSKOWITZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:835 COGBURN AVENUE NW
Mailing Address - Street 2:SUITE 250
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1031
Mailing Address - Country:US
Mailing Address - Phone:770-422-8815
Mailing Address - Fax:770-422-8816
Practice Address - Street 1:1790 MULKEY RD
Practice Address - Street 2:SUITE 1
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1122
Practice Address - Country:US
Practice Address - Phone:770-941-1013
Practice Address - Fax:770-941-9418
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2020-06-25
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Provider Licenses
StateLicense IDTaxonomies
GA020546207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD29820OtherPIN
D29820Medicare UPIN
GA202I077531Medicare PIN
202I074083Medicare PIN