Kiley Katherine Fagan
Dermatologist
775 Aronson Lake Ct
Roswell
, Georgia 30075-7172
Kiley Katherine Fagan
Dermatologist
775 Aronson Lake Ct
Roswell
, Georgia 30075-7172
(770) 296-3795
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About
Features
Specialties
- Dermatologist
Languages spoken
- English
Location
First Address
- Kiley Katherine Fagan
- 775 Aronson Lake Ct
- Roswell, GA
- Zip : 30075-7172
- Phone : (770) 296-3795
Second Address
- Kiley Katherine Fagan
- 775 Aronson Lake Ct
- Roswell, GA
- Zip : 30075-7172
- Phone : (770) 296-3795
Reviews
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Is Kiley Katherine Fagan accepting new patients?
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207N00000X | Dermatologist | 10808 | GA |
National Provider Identifier
| NPI | 1003479254 |
|---|---|
| Provider Name | Kiley Katherine Fagan |
| First Address | Roswell, GA 30075-7172 |
| Second Address | Roswell, GA 30075-7172 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 15/04/2019 |
| Last Update Date | 15/04/2019 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 10808 | (05) | GA |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.