Provider Demographics
NPI:1265205488
Name:SKIN CANCER CENTER OF NORTH GEORGIA PC
Entity type:Organization
Organization Name:SKIN CANCER CENTER OF NORTH GEORGIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-259-6553
Mailing Address - Street 1:10973 SE 175TH PL STE 100
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491-0905
Mailing Address - Country:US
Mailing Address - Phone:352-259-6553
Mailing Address - Fax:352-873-9397
Practice Address - Street 1:405 FANNIN INDUSTRIAL PARK
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-4191
Practice Address - Country:US
Practice Address - Phone:352-259-6553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-31
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty