Forefront Dermatology, S.C.
Organization Active NPI Dermatology Physician · St Simons Island, GA
NPI 1154938579 · NPPES record last updated Nov 19, 2020
Key facts
- NPI
- 1154938579
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dermatology Physician 207N00000X
- Legal business name
- FOREFRONT DERMATOLOGY, S.C.
- Practice address
- 7000 Wellness Way Ste 7120
St Simons Island, GA 31522-2286 - Phone
- (912) 634-4966
- Fax
- (912) 634-6542
- NPI assigned
- Sep 29, 2020
- Organization subpart
- No
Authorized official
- Name
- Dr. Betsy J Wernli, MD
- Title
- President
- Phone
- (920) 482-0671
Other NPIs on the same Medicare enrollment 4
Practitioners 4
-
Jordan Brooks, MD
-
Rachel Lauren Duncan, PA-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D1048004 | Forefront Dermatology SC Dba Atlantic Shore Derm | Certificate of waiver | Feb 4, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190611003824 | GA | Part B Supplier - Clinic/Group Practice | 3779471701 |
Receives reassigned benefits from 16 practitioners 4 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Brunswick, GA; Waycross, GA; Suwanee, GA; St Simons Island, GA; Cumming, GA; Alpharetta, GA; Atlanta, GA; Saint Marys, GA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician |
207N00000X | Yes | ||
| MOHS-Micrographic Surgery Physician |
207ND0101X | |||
| Procedural Dermatology Physician |
207NS0135X | |||
| Orthopaedic Surgery Physician |
207X00000X |
Addresses
Primary practice location
7000 Wellness Way Ste 7120
St Simons Island, GA 31522-2286
Mailing address
801 York St
Manitowoc, WI 54220-4630
Phone (920) 663-9008
Other practice location 1
400 Lister St
Waycross, GA 31501-5226
Phone (912) 283-4850
Other practice location 2
2804 Saint Marys Rd
Saint Marys, GA 31558-4559
Phone (912) 439-3186
Other names
- Atlantic Shore Dermatology, A Forefront Dermatology Practice
Other providers in St Simons Island, GA
- Elite Health Innovations LLC
- Emerald Isle Counseling LLC
- Genie Nall Fleet
- Elizabeth Y Fletcher
- Focus Healthcare of Georgia
- Tara Fox
- Jocelyn Francesconi
- Frederica Imaging PC
- Frederica Pharmacy Inc.
- Mark Fred Friedman
All providers in St Simons Island, GA · Dermatology Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 19, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.