NPIMap

Organization Active NPI

Aqua Dermatology of Georgia PC

Doing business as Goodman Dermatology, Skin Cancer Specialists PC & Aesthetics Center

  • Dermatology Physician
  • Marietta, GA
National Provider Identifier
1114022167
Registry record updated Sep 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
AQUA DERMATOLOGY OF GEORGIA PC
Doing business as
Goodman Dermatology, Skin Cancer Specialists PC & Aesthetics Center
Practice address
835 Cogburn Ave NW
Suite 100
Marietta, GA 30060-1031
Phone
(770) 422-5557
Fax
(770) 422-5456
NPI assigned
Sep 14, 2006
Last updated
Sep 16, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2024

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

Authorized official

Name
Dr. Theodore Schiff, MD
Title
Owner
Phone
(770) 422-5557

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU Primary
MOHS-Micrographic Surgery Physician 207ND0101X NU

Addresses

Primary practice location

835 Cogburn Ave NW
Suite 100
Marietta, GA 30060-1031

Mailing address

835 Cogburn Ave NW
Suite 100
Marietta, GA 30060-1031
Phone (770) 422-5557

Other names 1

  • Goodman Dermatology, Skin Cancer Specialists PC & Aesthetics Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040507000201 GA Part B Supplier - Clinic/Group Practice 6800885757 Receives reassigned benefits from 72 practitioners
1 other NPI on this enrollment
Practice locations: Lawrenceville, GA; Marietta, GA; Jasper, GA; Newnan, GA; Peachtree Corners, GA; Rome, GA; Roswell, GA; Sandy Springs, GA…

Other NPIs on the same Medicare enrollment 1

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D1016973Aqua Dermatology of Georgia , PC835 Cogburn Avenue, Marietta, GA 30060ComplianceNov 16, 2027

National Provider Directory

National Provider Directory

Locations

2870 Ronald Reagan Blvd
Ste 103
Cumming, GA 30041
Phone (248) 601-4900

5983 Highway 53 E
Ste 200
Dawsonville, GA 30534
Phone (770) 754-0787

835 Cogburn Ave NW
Marietta, GA 30060
Phone (770) 422-8815

835 Cogburn Ave NW
Ste 100
Marietta, GA 30060
Phone (770) 422-5557

835 Cogburn Ave NW
Ste 250
Marietta, GA 30060
Phone (770) 422-8815

835 Cogburn Ave NW
Ste 270
Marietta, GA 30060

2045 Highway 34 E
Newnan, GA 30265
Phone (770) 502-0202

18 Riverbend Dr SW
Ste 230SWE
Rome, GA 30161

Practitioners & affiliated clinicians

Practitioners 79

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 79

NPI Registry JSON

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726444800000",
    "number": "1114022167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "835 COGBURN AVE NW",
            "address_2": "SUITE 100",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601031",
            "telephone_number": "770-422-5557",
            "fax_number": "770-422-5456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "835 COGBURN AVE NW",
            "address_2": "SUITE 100",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601031",
            "telephone_number": "770-422-5557",
            "fax_number": "770-422-5456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AQUA DERMATOLOGY OF GEORGIA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-14",
        "last_updated": "2024-09-16",
        "certification_date": "2024-09-16",
        "status": "A",
        "authorized_official_last_name": "SCHIFF",
        "authorized_official_first_name": "THEODORE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-422-5557",
        "authorized_official_name_prefix": "Dr.",
        "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
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Goodman Dermatology, Skin Cancer Specialists PC & Aesthetics Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.