Baucom & Mina Derm Surgery, LLC

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

Legal business name

BAUCOM & MINA DERM SURGERY, LLC

Practice address

5555 Peachtree Dunwoody Rd
Suite 206
Atlanta, GA 30342-1703

Phone

(404) 844-0496

Fax

(404) 844-0499

NPI assigned

Oct 6, 2016

Organization subpart

No

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

Authorized official

Name

Mary Alice Mina, M.D.NPI 1538329149

Title

Owner

Phone

(404) 844-0496

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• ASC of Georgia Dermatologic Surgery

  • Ambulatory Surgical Clinic/Center
  • Atlanta, GA
  • NPI 1356429765

  Member Of

  NPD member

Locations

Practitioners 3

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

• Mary Alice Nading Mina, M.D.

  • MOHS-Micrographic Surgery Physician
  • Atlanta, GA
  • NPI 1538329149
  Medicare reassignment Care Compare group NPD Authorized official
• Mark Francis Baucom, M.D.

  • MOHS-Micrographic Surgery Physician
  • Atlanta, GA
  • NPI 1831184357
  Medicare reassignment Care Compare group NPD
• Erin L Watkins, P.A.

  • Physician Assistant
  • Alpharetta, GA
  • NPI 1992973556
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1475712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702425600000",
    "number": "1245780980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5555 PEACHTREE DUNWOODY RD",
            "address_2": "SUITE 206",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5555 PEACHTREE DUNWOODY RD",
            "address_2": "SUITE 206",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421703",
            "telephone_number": "404-844-0496",
            "fax_number": "404-844-0499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAUCOM & MINA DERM SURGERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-06",
        "last_updated": "2023-12-13",
        "certification_date": "2023-12-13",
        "status": "A",
        "authorized_official_last_name": "MINA",
        "authorized_official_first_name": "MARY ALICE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-844-0496",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Keenan Whitesides Batts, PT, DPT
• Kristen Logan Batts
• Smitha Battula, M.D.
• Marshet Batu, MD
• Christopher Batuello, M.D., PH.D.
• Mark Francis Baucom, M.D.
• Melissa Baudo, D.P.T.
• Erik M Bauer, M.D.
• John Bauer
• Negin Akbarshahi Bauer, PA-C

• MOHS-Micrographic Surgery Physician in Atlanta, GA
• Providers in Atlanta, GA by specialty
• MOHS-Micrographic Surgery Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2023; 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.