Provider Demographics
NPI:1063560803
Name:DERMATOLOGY ASSOCIATES OF GEORGIA, LLC
Entity type:Organization
Organization Name:DERMATOLOGY ASSOCIATES OF GEORGIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:R
Authorized Official - Last Name:STONECIPHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-321-4600
Mailing Address - Street 1:1951 CLAIRMONT RD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-3415
Mailing Address - Country:US
Mailing Address - Phone:404-321-4600
Mailing Address - Fax:404-320-0987
Practice Address - Street 1:1951 CLAIRMONT RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-3415
Practice Address - Country:US
Practice Address - Phone:404-321-4600
Practice Address - Fax:404-320-0987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty