Prosynergy Dermatology LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

PROSYNERGY DERMATOLOGY LLC

Practice address

111 Davis Rd
Martinez, GA 30907-2383

Phone

(706) 432-9285

Fax

(706) 432-9674

NPI assigned

Aug 3, 2023

Last updated

Aug 3, 2023By 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

Dr. Stephen Melvin Squires, MDNPI 1346476199

Title

Ceo and President

Phone

(706) 432-9285

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA, SC2 enrollments

Enrollment records 2

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

Practitioners 4

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.

• Stephen M Squires, M.D.

  • Dermatology Physician
  • Martinez, GA
  • NPI 1346476199

  SC

  Medicare reassignment Care Compare group NPD Authorized official
• Morgan Toole Cummings, PA-C

  • Physician Assistant
  • Martinez, GA
  • NPI 1659655462
  Medicare reassignment Care Compare group
• Benjamin Kilpatrick

  • Physician Assistant
  • Augusta, GA
  • NPI 1487055091

  SC

  Medicare reassignment Care Compare group
• Michelle Nye

  • Physician Assistant
  • Augusta, GA
  • NPI 1578113072

  SC

  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1691020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691020800000",
    "number": "1205518875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 DAVIS RD",
            "city": "MARTINEZ",
            "state": "GA",
            "postal_code": "309072383",
            "telephone_number": "706-432-9285",
            "fax_number": "706-432-9674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 DAVIS RD",
            "city": "MARTINEZ",
            "state": "GA",
            "postal_code": "309072383",
            "telephone_number": "706-432-9285",
            "fax_number": "706-432-9674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROSYNERGY DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-03",
        "last_updated": "2023-08-03",
        "certification_date": "2023-08-03",
        "status": "A",
        "authorized_official_last_name": "SQUIRES",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "MELVIN",
        "authorized_official_title_or_position": "CEO AND PRESIDENT",
        "authorized_official_telephone_number": "706-432-9285",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in Martinez, GA
• Providers in Martinez, 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 3, 2023; 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.