Dermatology Center of Atlanta

Primary specialty

SpecialistTaxonomy code 174400000X

License

040083 Issued in GA

Legal business name

DERMATOLOGY CENTER OF ATLANTA

Practice address

9900 Medlock Bridge Rd
Duluth, GA 30097-2017

Phone

(770) 497-0699

Fax

(770) 497-0388

NPI assigned

Nov 21, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Leslie C Gray, MDNPI 1720082084

Title

Owner

Phone

(770) 497-0699

Specialties & licenses 1

Addresses

Other identifiers 1

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

Practitioners 8

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

• Leslie C Gray, M.D.

  • Specialist
  • Duluth, GA
  • NPI 1720082084
  Medicare reassignment Care Compare group NPD Authorized official
• Kristin Hendren Magee, M.D.

  • Dermatology Physician
  • Duluth, GA
  • NPI 1205013141
  Medicare reassignment Care Compare group NPD
• Stephanie Crews, PA-C

  • Physician Assistant
  • Atlanta, GA
  • NPI 1568131142
  Medicare reassignment Care Compare group
• Nathina Scarlett Melton, PA-C

  • Medical Physician Assistant
  • Duluth, GA
  • NPI 1376848549
  Medicare reassignment Care Compare group
• Danielle Wiseley, PA-C

  • Physician Assistant
  • Columbus, GA
  • NPI 1912379421
  Medicare reassignment Care Compare group
• Lisa M Foreman, NP-C

  • Nurse Practitioner
  • Duluth, GA
  • NPI 1174510036
  Medicare reassignment NPD
• Sharon Staruch-Christopher, PA

  • Medical Physician Assistant
  • Lawrenceville, GA
  • NPI 1720332851
  Medicare reassignment
• Janet Lorraine Haley, ARNP

  • Nurse Practitioner
  • Austell, GA
  • NPI 1912487786
  NPD

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560384000000",
    "number": "1295800803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9900 MEDLOCK BRIDGE RD",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300972017",
            "telephone_number": "770-497-0699",
            "fax_number": "770-497-0388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9900 MEDLOCK BRIDGE RD",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300972017",
            "telephone_number": "770-497-0699",
            "fax_number": "770-497-0388"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY CENTER OF ATLANTA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-21",
        "last_updated": "2019-06-13",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-497-0699",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "GA",
            "license": "040083",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP",
            "identifier": "CK6511",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Bernadette Joan Dewit
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• Patricia Gray Di Rito, MA, LAPC

• Specialist in Duluth, GA
• Providers in Duluth, GA by specialty
• Specialist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2019; 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.