Atlantic Dermatology LLC

Primary specialty

Procedural Dermatology PhysicianTaxonomy code 207NS0135X

Legal business name

ATLANTIC DERMATOLOGY LLC

Practice address

1980 N Atlantic Ave
Suite 722
Cocoa Beach, FL 32931-5213

Phone

(321) 784-8811

Fax

(321) 799-4424

NPI assigned

Aug 31, 2006

Organization subpart

No

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

Authorized official

Name

Mrs. Kristin Widick Smallwood, M.D.NPI 1346350352

Title

President

Phone

(321) 784-8811

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

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

• Kristin Widick Smallwood, M.D.

  • Pediatric Dermatology Physician
  • Cocoa Beach, FL
  • NPI 1346350352
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1306957378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1980 N ATLANTIC AVE",
            "address_2": "SUITE 722",
            "city": "COCOA BEACH",
            "state": "FL",
            "postal_code": "329315213",
            "telephone_number": "321-784-8811",
            "fax_number": "321-799-4424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1980 N ATLANTIC AVE",
            "address_2": "SUITE 722",
            "city": "COCOA BEACH",
            "state": "FL",
            "postal_code": "329315213",
            "telephone_number": "321-784-8811",
            "fax_number": "321-799-4424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATLANTIC DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "SMALLWOOD",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_middle_name": "WIDICK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "321-784-8811",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NI0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Clinical & Laboratory Dermatological Immunology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Procedural Dermatology Physician in Cocoa Beach, FL
• Providers in Cocoa Beach, FL by specialty
• Procedural Dermatology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.