Provider Demographics
NPI:1902538770
Name:ATLANTA SKIN WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:ATLANTA SKIN WELLNESS CENTER LLC
Other - Org Name:ATLANTA SKIN WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWER/MD
Authorized Official - Prefix:DR
Authorized Official - First Name:ELISE
Authorized Official - Middle Name:P
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-446-4840
Mailing Address - Street 1:755 MOUNT VERNON HWY NE STE 305
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4290
Mailing Address - Country:US
Mailing Address - Phone:404-446-4840
Mailing Address - Fax:404-446-4841
Practice Address - Street 1:755 MOUNT VERNON HWY NE STE 305
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4290
Practice Address - Country:US
Practice Address - Phone:404-351-7546
Practice Address - Fax:404-351-2993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-29
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty