Provider Demographics
NPI:1144493396
Name:FAMILY DERMATOLOGY, P.C.
Entity type:Organization
Organization Name:FAMILY DERMATOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DELE
Authorized Official - Middle Name:
Authorized Official - Last Name:YUDOWI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-231-5279
Mailing Address - Street 1:629 BEAVER RUIN RD NW
Mailing Address - Street 2:SUITE B
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-3401
Mailing Address - Country:US
Mailing Address - Phone:770-921-4300
Mailing Address - Fax:770-381-6451
Practice Address - Street 1:629 BEAVER RUIN RD NW
Practice Address - Street 2:SUITE B
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-3401
Practice Address - Country:US
Practice Address - Phone:770-921-4300
Practice Address - Fax:770-381-6451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty