| NPI | 1114100377 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENDRA ANN COLE Owner 678-417-6900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: GA 030406) |
| Enumeration Date | 2007-12-11 |
| Last Update Date | 2011-12-19 |