Modern Dermatology Atlanta

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

57104 Issued in GA

Legal business name

MODERN DERMATOLOGY ATLANTA

Practice address

5696 Whitehall Walk
Dunwoody, GA 30338

Phone

(423) 280-2594

NPI assigned

Aug 11, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Naga B Meduri, MDNPI 1346344405

Title

Owner

Phone

(423) 280-2594

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Naga Bhavani Meduri, MD

  • Dermatology Physician
  • Cumming, GA
  • NPI 1346344405
  Medicare reassignment Care Compare group NPD Authorized official
• Madeline Kate Shedd, PA-C

  • Physician Assistant
  • Woodstock, GA
  • NPI 1487541090
  Medicare reassignment Care Compare group NPD
• Amy Theobald Colon, PA-C

  • Medical Physician Assistant
  • Alpharetta, GA
  • NPI 1164988143
  Medicare reassignment

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

{
    "created_epoch": "1502409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1502409600000",
    "number": "1164947115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5696 WHITEHALL WALK",
            "city": "DUNWOODY",
            "state": "GA",
            "postal_code": "303382655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5696 WHITEHALL WALK",
            "city": "DUNWOODY",
            "state": "GA",
            "postal_code": "30338",
            "telephone_number": "423-280-2594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN DERMATOLOGY ATLANTA",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-11",
        "last_updated": "2017-08-11",
        "status": "A",
        "authorized_official_last_name": "MEDURI",
        "authorized_official_first_name": "NAGA",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "423-280-2594",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "GA",
            "license": "57104",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaska Danica Miskolczi
• Amar Mistry, DDS
• Lamont Allen Mitchell
• Kristin Mize, LCSW
• Mobile Wound Care Services of Atlanta Inc
• Mommy Angels Specialty Care Inc.
• Carolina Montoya
• Joel Moorhead, MD, MPH, PHD
• Mary Faith Morgan, LPC
• Alicja Morgas

• Dermatology Physician in Dunwoody, GA
• Providers in Dunwoody, GA by specialty
• Dermatology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2017; 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.