Provider Demographics
NPI:1538359617
Name:BUCKHEAD DERMATOLOGY
Entity type:Organization
Organization Name:BUCKHEAD DERMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERRIE-ANN
Authorized Official - Middle Name:V
Authorized Official - Last Name:STRAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-816-4000
Mailing Address - Street 1:PO BOX 53136
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30355-1136
Mailing Address - Country:US
Mailing Address - Phone:404-816-4000
Mailing Address - Fax:404-816-4020
Practice Address - Street 1:2961 HARDMAN CT NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-3424
Practice Address - Country:US
Practice Address - Phone:404-816-4000
Practice Address - Fax:404-816-4020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033207207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00516656BMedicaid
GAF365770Medicare UPIN
GA00516656BMedicaid