Med Therapeutic Skin Care Day Spa

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

License

2013005065 Issued in GA

Legal business name

MED THERAPEUTIC SKIN CARE DAY SPA

Practice address

5344 Jimmy Carter Blvd
1 C
Norcross, GA 30093-1516

Phone

(770) 849-0206

Fax

(770) 849-0206

NPI assigned

May 15, 2013

Last updated

May 15, 2013By 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

Lidia Mosquera, LPG

Title

Owner

Phone

(770) 849-0206

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1368576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368576000000",
    "number": "1568808731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5344 JIMMY CARTER BLVD",
            "address_2": "1 C",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300931516",
            "telephone_number": "770-849-0206",
            "fax_number": "770-849-0206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5344 JIMMY CARTER BLVD",
            "address_2": "1 C",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "300931516",
            "telephone_number": "770-849-0206",
            "fax_number": "770-849-0206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MED THERAPEUTIC SKIN CARE DAY SPA",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-15",
        "last_updated": "2013-05-15",
        "status": "A",
        "authorized_official_last_name": "MOSQUERA",
        "authorized_official_first_name": "LIDIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-849-0206",
        "authorized_official_credential": "LPG"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "GA",
            "license": "2013005065",
            "primary": false
        },
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "GA",
            "license": "2013005065",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan Beth McGinnis, NP
• Marye Angelyn McKenney, RN, MSN, APRN
• Dana McNeil, FNP
• MDC Therapeutic Services LLC
• Mead Medical Group LLC
• Medciphers LLC (MDC Homecare)
• Medi Lyft LLC
• Medical Aid Supply House Inc
• Medical Concepts in Vision
• Medical Equipment Supply Place Inc

• Exclusive Provider Organization in Norcross, GA
• Providers in Norcross, GA by specialty
• Exclusive Provider Organization in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2013; 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.