Aesthetic Dermatology, PC
Organization Active NPI Dermatology Physician · Cumming, GA
NPI 1639313489 · NPPES record last updated Jul 27, 2009
Key facts
- NPI
- 1639313489
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dermatology Physician 207N00000X
- License
- 059398 (GA)
- Legal business name
- AESTHETIC DERMATOLOGY, PC
- Practice address
- 960 Sanders Rd
Suite 300
Cumming, GA 30041-5962 - Phone
- (770) 205-0104
- Fax
- (770) 205-0975
- NPI assigned
- Apr 23, 2009
- Organization subpart
- No
Authorized official
- Name
- Trisha Daley, MD
- Title
- President/Physician
- Phone
- (770) 205-0104
Practitioners 1
-
Trisha N Daley, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090626000293 | GA | Part B Supplier - Clinic/Group Practice | 3870644172 |
Receives reassigned benefits from 1 practitioner Practice locations: Cumming, GA |
National Provider Directory
Locations
960 Sanders Rd
Ste 300
Cumming, GA 30041
Phone (770) 205-0104
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician |
207N00000X | 059398 | GA | Yes |
Addresses
Primary practice location
960 Sanders Rd
Suite 300
Cumming, GA 30041-5962
Mailing address
960 Sanders Rd
Suite 300
Cumming, GA 30041-5962
Phone (770) 205-0104
Other providers in Cumming, GA
- Advanced Park Wellness LLC
- Advanced Urology Institute of Georgia, PC
- Advanced Urology Institute of Georgia, PC
- Aegis Endoscopy LLC
- Aegis Group Practice LLC
- Affiliated Psychological Services, PC
- Ageless Design Inc.
- Thompson Agyemang
- Jennifer Ahlswede
- Kanita Ahmad
All providers in Cumming, GA · Dermatology Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 27, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.