Organization Active NPI

Atlanta West Dermatology & Surgery Center PC

  • Dermatology Physician
  • Austell, GA
National Provider Identifier
1174680979
Registry record updated Mar 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
028477 Issued in GA
Legal business name
ATLANTA WEST DERMATOLOGY & SURGERY CENTER PC
Practice address
1550 Mulkey Rd
Austell, GA 30106-1112
Phone
(770) 732-1137
Fax
(770) 732-2081
NPI assigned
Jan 2, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2026

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

Authorized official

Name
Christy Hall
Title
Office Manager
Phone
(770) 732-1137

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X 028477 GA Primary

Addresses

Primary practice location

1550 Mulkey Rd
Austell, GA 30106-1112

Mailing address

1550 Mulkey Rd
Austell, GA 30106-1112
Phone (770) 732-1137

Other practice location 1

2850 Paces Ferry Rd SE Ste 450
Atlanta, GA 30339-5725
Phone (770) 732-1137

Other names 1

  • Atlanta West Dermatology PC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041202000177 GA Part B Supplier - Clinic/Group Practice 9638135692 Receives reassigned benefits from 6 practitioners
Practice locations: Atlanta, GA; Austell, GA

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
11D0724381Atlanta West Dermatology PC1550 Mulkey Road, Austell, GA 30106ComplianceJul 31, 2026
11D2335064Atlanta West Dermatology PC2850 Paces Ferry Road, Suite 450, Atlanta, GA 30339RegistrationDec 4, 2027

National Provider Directory

National Provider Directory

Locations

3400 Old Milton Pkwy
Ste C555
Alpharetta, GA 30005
Phone (404) 446-3200

2850 Paces Ferry Rd SE
Ste 450
Atlanta, GA 30339
Phone (770) 732-1137

1700 Hospital South Dr
Ste 101
Austell, GA 30106
Phone (770) 732-1137

Practitioners & affiliated clinicians

Practitioners 8

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

NPI Registry JSON

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773273600000",
    "number": "1174680979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1550 MULKEY RD",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301061112",
            "telephone_number": "770-732-1137",
            "fax_number": "770-732-2081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1550 MULKEY RD",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301061112",
            "telephone_number": "770-732-1137",
            "fax_number": "770-732-2081"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2850 Paces Ferry Rd SE Ste 450",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303395725",
            "country_code": "US",
            "telephone_number": "770-732-1137",
            "fax_number": "770-732-2081",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ATLANTA WEST DERMATOLOGY & SURGERY CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-02",
        "last_updated": "2026-03-12",
        "certification_date": "2026-03-12",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "CHRISTY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "770-732-1137"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "GA",
            "license": "028477",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Atlanta West Dermatology PC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Austell, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2026; 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.