NPIMap

Organization Active NPI

Douglas Dermatology and Skin Cancer Specialists LLC

  • Dermatology Physician
  • Douglasville, GA
National Provider Identifier
1275929267
Registry record updated Jan 4, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
DOUGLAS DERMATOLOGY AND SKIN CANCER SPECIALISTS LLC
Practice address
4645 Timber Ridge Dr
Suite 100
Douglasville, GA 30135-7541
Phone
(678) 702-3376
Fax
(678) 909-0446
NPI assigned
Apr 7, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2017

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

Authorized official

Name
Firas George Hougeir, MDNPI 1023095957
Title
Owner
Phone
(678) 702-3376

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

4645 Timber Ridge Dr
Suite 100
Douglasville, GA 30135-7541

Mailing address

151 Southhall LN
Suite 300
Maitland, FL 32751-7176
Phone (407) 875-2080

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151012000999 GA Part B Supplier - Clinic/Group Practice 1658680764 Receives reassigned benefits from 12 practitioners
Practice locations: Atlanta, GA; Cartersville, GA; Columbus, GA; Douglasville, GA; Rome, GA

National Provider Directory

National Provider Directory

Locations

400 Brookstone Centre Pkwy
Ste 200
Columbus, GA 31904
Phone (706) 507-3332

Practitioners & affiliated clinicians

Practitioners 12

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": "1428364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1483488000000",
    "number": "1275929267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 SOUTHHALL LN",
            "address_2": "SUITE 300",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327517176",
            "telephone_number": "407-875-2080",
            "fax_number": "407-650-3455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4645 TIMBER RIDGE DR",
            "address_2": "SUITE 100",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301357541",
            "telephone_number": "678-702-3376",
            "fax_number": "678-909-0446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOUGLAS DERMATOLOGY AND SKIN CANCER SPECIALISTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-07",
        "last_updated": "2017-01-04",
        "status": "A",
        "authorized_official_last_name": "HOUGEIR",
        "authorized_official_first_name": "FIRAS",
        "authorized_official_middle_name": "GEORGE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-702-3376",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Douglasville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2017; 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.