Provider Demographics
NPI:1053565580
Name:JOHNS CREEK DERMATOLOGY AND FAMILY MEDICINE, P.C.
Entity type:Organization
Organization Name:JOHNS CREEK DERMATOLOGY AND FAMILY MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TIMANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-771-6591
Mailing Address - Street 1:6300 HOSPITAL PKWY
Mailing Address - Street 2:STE 100
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097
Mailing Address - Country:US
Mailing Address - Phone:770-771-6591
Mailing Address - Fax:770-771-6599
Practice Address - Street 1:6300 HOSPITAL PKWY
Practice Address - Street 2:STE 100
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097
Practice Address - Country:US
Practice Address - Phone:770-771-6591
Practice Address - Fax:770-771-6599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-11
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA061526207N00000X, 207ND0900X
GA061566207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1982602074OtherDR. AHMAD CHARKAWI
GA1851505077OtherDR SHEREEN TIMANI
GA437442038AMedicaid
GA511G41701297Medicare PIN