Dermatopathology Lab of Skin Cancer Specialists, P.C.

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

DERMATOPATHOLOGY LAB OF SKIN CANCER SPECIALISTS, P.C.

Practice address

175 White Street
Suite 370
Marietta, GA 30060-1054

Phone

(770) 422-5557

Fax

(770) 422-8816

NPI assigned

Nov 20, 2013

Last updated

Nov 20, 2013By the provider in NPPES

Organization subpart

Yes

Parent organization

SKIN CANCER SPECIALISTS P.CAs reported in NPPES

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

Authorized official

Name

Mark A. Chastain, M.D., M.D.

Title

President

Phone

(770) 422-5557

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Aqua Dermatology of Georgia PC

  dba Goodman Dermatology, Skin Cancer Specialists PC & Aesthetics Center

  • Dermatology Physician
  • Marietta, GA
  • NPI 1114022167

  O20040507000201

  Same enrollment

Part of

Aqua Dermatology of Georgia

Locations

Practitioners 45

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.

• Maci Benveniste

  • Medical Physician Assistant
  • Roswell, GA
  • NPI 1750270229
  NPD
• Meera Brahmbhatt, M.D.

  • Dermatopathology Physician
  • Marietta, GA
  • NPI 1750816716
  NPD
• Jennifer Louise Buckley, MD

  • Dermatology Physician
  • Marietta, GA
  • NPI 1215908652
  NPD
• Francesca Maria Ceci, MD

  • Dermatology Physician
  • Roswell, GA
  • NPI 1225666431
  NPD
• Lynn D Cooper, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Marietta, GA
  • NPI 1366658437
  NPD
• Claudette Louise Corey, NP

  • Acute Care Nurse Practitioner
  • Marietta, GA
  • NPI 1497205777
  NPD
• Lauren Daugherty, MD

  • Dermatology Physician
  • Peachtree City, GA
  • NPI 1538690474
  NPD
• Kenzie Dittmar, PA

  • Physician Assistant
  • Dallas, GA
  • NPI 1265228795
  NPD
• Alyssa Michelle Einstein, NP-C

  • Nurse Practitioner
  • Marietta, GA
  • NPI 1417710286
  NPD
• Chloe Standridge Fernandez, DO

  • Dermatology Physician
  • Roswell, GA
  • NPI 1912649690
  NPD
• Dorothy Rodenbeck Fernandez, MD

  • Dermatology Physician
  • Atlanta, GA
  • NPI 1033572078
  NPD
• Jacqueline Nicole Flandry, M.D.

  • Dermatology Physician
  • Columbus, GA
  • NPI 1306089800
  NPD

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

{
    "created_epoch": "1384905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384905600000",
    "number": "1083044465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 WHITE STREET",
            "address_2": "SUITE 175",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601054",
            "telephone_number": "770-422-5557",
            "fax_number": "770-422-8816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 WHITE STREET",
            "address_2": "SUITE 370",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601054",
            "telephone_number": "770-422-5557",
            "fax_number": "770-422-8816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOPATHOLOGY LAB OF SKIN CANCER SPECIALISTS, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SKIN CANCER SPECIALISTS P.C",
        "enumeration_date": "2013-11-20",
        "last_updated": "2013-11-20",
        "status": "A",
        "authorized_official_last_name": "CHASTAIN, M.D.",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "770-422-5557",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Whitney S Denton, M.D.
• Denward Healthy Living Inc
• Damon Robert Denzin, PHYSICIAN ASSISTANT
• John Carmen Dercola, PA
• Dermatology and Surgery Specialists of North Atlanta PC
• Daksha Desai, BPHARM
• Hardi Desai
• Jay Desai
• Sheetal Desai, D.O.
• Benjamin W Deshetler, D.D.S.

• Clinical Medical Laboratory in Marietta, GA
• Providers in Marietta, GA by specialty
• Clinical Medical Laboratory in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2013; 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.