NPIMap

Organization Active NPI

Georgia Dermatology & Skin Cancer Center, LLC

  • Dermatology Physician
  • Dublin, GA
National Provider Identifier
1063460459
Registry record updated Oct 30, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
GEORGIA DERMATOLOGY & SKIN CANCER CENTER, LLC
Practice address
2400 Bellevue Rd
16 Erin Office Park
Dublin, GA 31021-2885
Phone
(478) 328-0281
Fax
(478) 328-0438
NPI assigned
May 5, 2006
Last updated
Oct 30, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michael J Sharkey, MDNPI 1417941964
Title
Owner
Phone
(478) 275-2694

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU Primary
MOHS-Micrographic Surgery Physician 207ND0101X NU
Dermatopathology Physician 207ND0900X NU
Clinical & Laboratory Dermatological Immunology Physician 207NI0002X NU
Pediatric Dermatology Physician 207NP0225X NU
Procedural Dermatology Physician 207NS0135X NU
Dermatopathology (Pathology) Physician 207ZD0900X NU

Addresses

Primary practice location

2400 Bellevue Rd
16 Erin Office Park
Dublin, GA 31021-2885

Mailing address

2400 Bellevue Rd Ste 21a
Dublin, GA 31021-2890
Phone (478) 328-0281

Other identifiers 1

IdentifierTypeStateIssuer
DC4061OtherGARAILROAD MEDICARE

Other names 1

  • Georgia Dermatology & Skin Care Center Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041104000512 GA Part B Supplier - Clinic/Group Practice 7113980855 Receives reassigned benefits from 59 practitioners
Practice locations: Jesup, GA; Thomaston, GA; Macon, GA; Milledgeville, GA; Richmond Hill, GA; Roswell, GA; Savannah, GA; St Simons Island, GA…
O20190923000029 SC Part B Supplier - Clinic/Group Practice 7113980855 Receives reassigned benefits from 6 practitioners
Practice locations: Aiken, SC

National Provider Directory

National Provider Directory

Locations

631 E Forsyth St
Americus, GA 31709
Phone (229) 924-6006

1349 Milstead Rd NE
Conyers, GA 30012
Phone (770) 785-7546

110 Bowens Mill Rd
Douglas, GA 31533
Phone (912) 384-3204

1380 Gordon St W
Douglas, GA 31533
Phone (912) 384-3204

2400 Bellevue Rd
Ste 16
Dublin, GA 31021
Phone (478) 275-2694

182 Perry House Rd
Ste C
Fitzgerald, GA 31750
Phone (229) 424-0396

101 Martin Luther King Jr Dr
Forsyth, GA 31029
Phone (478) 994-5281

656 S 8th St
Griffin, GA 30224
Phone (404) 228-2824

980 S 1st St
Jesup, GA 31545
Phone (912) 427-4267

1157 Forsyth St
Macon, GA 31201
Phone (478) 745-8581

230 N Jefferson St NE
Milledgeville, GA 31061
Phone (478) 453-8484

415 E Crossville Rd
Roswell, GA 30075
Phone (770) 642-4644

405 W Main St
Thomaston, GA 30286
Phone (706) 647-2474

2002 Tebeau St
Waycross, GA 31501
Phone (912) 283-5676

Practitioners & affiliated clinicians

Practitioners 64

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 64

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193702400000",
    "number": "1063460459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 BELLEVUE RD STE 21A",
            "city": "DUBLIN",
            "state": "GA",
            "postal_code": "310212890",
            "telephone_number": "478-328-0281",
            "fax_number": "478-328-0438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 BELLEVUE RD",
            "address_2": "16 ERIN OFFICE PARK",
            "city": "DUBLIN",
            "state": "GA",
            "postal_code": "310212885",
            "telephone_number": "478-328-0281",
            "fax_number": "478-328-0438"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEORGIA DERMATOLOGY & SKIN CANCER CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-05",
        "last_updated": "2007-10-30",
        "status": "A",
        "authorized_official_last_name": "SHARKEY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "478-275-2694",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207ND0900X",
            "taxonomy_group": "",
            "desc": "Dermatology, Dermatopathology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207NI0002X",
            "taxonomy_group": "",
            "desc": "Dermatology, Clinical & Laboratory Dermatological Immunology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207ZD0900X",
            "taxonomy_group": "",
            "desc": "Pathology, Dermatopathology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DC4061",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Georgia Dermatology & Skin Care Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Dublin, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.