SUPRIYA IMMANENI MD
Individual Provider (NPI-1)
Active
Dermatology, MOHS-Micrographic Surgery
Provider Information
- NPI Number
1497129399- Provider Type
- Individual Provider (NPI-1)
- Credentials
- MD
- Status
- Active
Contact & Location
- Address
- 308 COLISEUM DR ST 200, MACON, GA, 312173865
- Phone
- (478) 742-2180
Specialties & Taxonomies
Dermatology
License: GA #95284
Dermatology, MOHS-Micrographic Surgery
Primary License: GA #95284