Evans Dermatology, LLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

0576116 Issued in GA

Legal business name

EVANS DERMATOLOGY, LLC

Practice address

902 Ponder Place CT
Evans, GA 30809-3184

Phone

(706) 922-3376

Fax

(706) 922-5643

NPI assigned

Sep 9, 2008

Last updated

Nov 7, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Frances Florentino, MDNPI 1255421475

Title

Member

Phone

(407) 595-4859

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 5

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.

• Frances T. Florentino, MD

  • Dermatology Physician
  • Evans, GA
  • NPI 1255421475
  Medicare reassignment Care Compare group Authorized official
• Savanna Perry, PA-C

  • Physician Assistant
  • Evans, GA
  • NPI 1497155899
  Medicare reassignment Care Compare group
• Kirstin Shaffer, PA

  • Physician Assistant
  • Evans, GA
  • NPI 1619754512
  Medicare reassignment Care Compare group
• Tracey Shaffer, PA

  • Physician Assistant
  • Thomson, GA
  • NPI 1598137564
  Medicare reassignment Care Compare group
• Catherine Heather Kitchens, PA-C

  • Physician Assistant
  • Augusta, GA
  • NPI 1588991913
  Medicare reassignment

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

{
    "created_epoch": "1220918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226016000000",
    "number": "1083862577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "902 PONDER PLACE CT",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308093184",
            "telephone_number": "706-922-3376",
            "fax_number": "706-922-5643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "902 PONDER PLACE CT",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308093184",
            "telephone_number": "706-922-3376",
            "fax_number": "706-922-5643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVANS DERMATOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-09",
        "last_updated": "2008-11-07",
        "status": "A",
        "authorized_official_last_name": "FLORENTINO",
        "authorized_official_first_name": "FRANCES",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "407-595-4859",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "GA",
            "license": "0576116",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erw Cin LLC
• Ryckia Estes, RBT
• Eugene H Williamson D.D.S.,M.S.,P.C.
• Evans Dental Group, LLC
• Evans Dental Group, PC
• Evans Dialysis Center LLC
• Evans Imaging, LLC
• Evans Injury Chiropractic LLC
• Evans Medical Group
• Evans Mental Health Associates

• Specialist in Evans, GA
• Providers in Evans, GA by specialty
• Specialist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2008; 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.