Live Oak Dermatology

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

LIVE OAK DERMATOLOGY

Practice address

135 Norcross St # 8
Roswell, GA 30075-3867

Phone

(678) 870-2020

NPI assigned

Sep 17, 2018

Last updated

Jul 22, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Brent Goedjen, MDNPI 1912292657

Title

Ceo

Phone

(678) 870-2020

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

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

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://app.meldrx.com/api/fhir/ez_00191

Practitioners 1

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.

• Brent Thomas Goedjen, M.D.

  • Dermatology Physician
  • Roswell, GA
  • NPI 1912292657
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1537142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658448000000",
    "number": "1194209163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 NORCROSS ST # 8",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300753867",
            "telephone_number": "678-870-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 NORCROSS ST # 8",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300753867",
            "telephone_number": "678-870-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVE OAK DERMATOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-17",
        "last_updated": "2022-07-22",
        "certification_date": "2022-07-22",
        "status": "A",
        "authorized_official_last_name": "GOEDJEN",
        "authorized_official_first_name": "BRENT",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "678-870-2020",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christine Elaine Liss, LCSW
• Little Futures LLC
• Derek Bentley Little, DPT
• Andrew Downs Littlefield
• Live Able Collective
• Living Healthy Solutions, LLC C/O Seva
• Pamela Livingston-Hardy, MLSW
• Kelli Ranson Lloyd, DPT
• Dunia Giselle Lobo, LPC
• Allison Lockhart, M.M., MT-BC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2022; 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.