Patrick Derouen, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

004076 Issued in GA

Practice address

1550 Mulkey Rd
Austell, GA 30106-1112

Phone

(404) 446-1440

Fax

(770) 732-2081

NPI assigned

Jan 2, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Atlanta West Dermatology & Surgery Center PC

  dba Atlanta West Dermatology PC

  • Dermatology Physician
  • Austell, GA
  • NPI 1174680979
  Medicare reassignment
• Advanced Dermatology,P.C.

  • Specialist
  • Douglasville, GA
  • NPI 1932360757
  NPD (past)

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1184781999",
    "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": "404-446-1440",
            "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": "404-446-1440",
            "fax_number": "770-732-2081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEROUEN",
        "first_name": "PATRICK",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "004076",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Despina Demestihas Dalton, MD
• Denmark Surgical Associates
• Dentalogy LLC (West Cobb Dental Studio)
• Dentistry for Children of Austell, LLC
• George T Deriso III, M.D.
• Gary Derusso II, MD
• Ketan N. Desai, DO
• Prakash V Desai, M.D.
• Swetang P Desai, MD
• Usha P Desai, MD

• Medical Physician Assistant in Austell, GA
• Providers in Austell, GA by specialty
• Medical Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.