Provider Demographics
NPI:1396087680
Name:SURGICAL & COSMETIC DERMATOLOGY, P. C.
Entity type:Organization
Organization Name:SURGICAL & COSMETIC DERMATOLOGY, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAIVID
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:HARVEY
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:770-400-8400
Mailing Address - Street 1:1615 HIGHWAY 34 E STE B
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-1325
Mailing Address - Country:US
Mailing Address - Phone:770-400-8400
Mailing Address - Fax:770-400-8401
Practice Address - Street 1:1615 HIGHWAY 34 E STE B
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265
Practice Address - Country:US
Practice Address - Phone:770-400-8400
Practice Address - Fax:770-400-8401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-25
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty