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| Type | Company | [sources] | |||
|---|---|---|---|---|---|
| Name | FAMILY DERMATOLOGY OF PENNSYLVANIA, PC · Family Dermatology of Pennsylvania, PC | [sources] | |||
| Incorporation date | not available | [sources] | |||
| Jurisdiction | not available | [sources] | |||
| Country | United States of America | [sources] | |||
| NPI | 1669482105 | [sources] | |||
| Registration number | not available | [sources] | |||
| Sector | DERMATOLOGIST | [sources] | |||
| Tax Number | 205288226 | [sources] | |||
| Address | (GA), (GA) | [sources] | |||
| Last change | Last processed | First seen | |||
Medical providers who are precluded from participation in the Medical Assistance Program
United States of America · DHS
Providers who have been terminated for cause from Georgia's Medicaid program.
United States of America · DCH
us-medpa-6a728f25676311de797343d2ad920d930633a071 · us-medga-93dcfcb533b5bf8e346b62fde7c5d74000ac535cFor experts: raw data explorer
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| Sanctions | |||||
|---|---|---|---|---|---|
| Country | Authority | Program | Start date | End date | |
| United States of America | Georgia Department of Community Health | - | |||
| United States of America | Department of Human Services | - | |||
| Address | ||
|---|---|---|
| Full address | Country | |
| (GA), (GA) · GA, GA | United States of America | |