Augusta Centre for Dermatology & Skin Renewal LLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

022436 Issued in GA

Legal business name

AUGUSTA CENTRE FOR DERMATOLOGY & SKIN RENEWAL LLC

Practice address

3614 J Dewey Gray Cir
Ste B
Augusta, GA 30909-6602

Phone

(706) 447-3909

NPI assigned

Oct 7, 2015

Last updated

Oct 7, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Anne M Loebl, MD

Title

Owner

Phone

(706) 447-3909

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1444176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444176000000",
    "number": "1255702940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3614 J DEWEY GRAY CIR",
            "address_2": "STE B",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309096602",
            "telephone_number": "706-447-3909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3614 J DEWEY GRAY CIR",
            "address_2": "STE B",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309096602",
            "telephone_number": "706-447-3909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUGUSTA CENTRE FOR DERMATOLOGY & SKIN RENEWAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-07",
        "last_updated": "2015-10-07",
        "status": "A",
        "authorized_official_last_name": "LOEBL",
        "authorized_official_first_name": "ANNE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "706-447-3909",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "GA",
            "license": "022436",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Medical Specialty Clinic/Center in Augusta, GA
• Providers in Augusta, GA by specialty
• Medical Specialty Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.