Provider Demographics
NPI:1679158885
Name:SPRINGS DERMATOLOGY, LLC
Entity type:Organization
Organization Name:SPRINGS DERMATOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELGADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-771-6591
Mailing Address - Street 1:6400 BLUE STONE RD STE 150
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4220
Mailing Address - Country:US
Mailing Address - Phone:470-769-9400
Mailing Address - Fax:470-769-9402
Practice Address - Street 1:6400 BLUE STONE RD STE 150
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-4220
Practice Address - Country:US
Practice Address - Phone:470-769-9400
Practice Address - Fax:470-769-9402
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHNS CREEK DERMATOLOGY AND FAMILY MEDICINE, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty