Thacker Dermatology LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

THACKER DERMATOLOGY LLC

Practice address

4233 Camelot Crossing
Valdosta, GA 31602

Phone

(229) 469-4383

Fax

(229) 469-4584

NPI assigned

Mar 17, 2011

Last updated

Oct 26, 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

Betsy Perry Thacker

Title

Owner

Phone

(229) 469-4383

Specialties & licenses 1

Addresses

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 16

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.

• Betsy Perry Backe, M.D.

  • Dermatology Physician
  • Valdosta, GA
  • NPI 1457554131
  Medicare reassignment Care Compare group NPD
• Candis Saunders Davis, RN

  • Family Nurse Practitioner
  • Valdosta, GA
  • NPI 1679987804
  Medicare reassignment Care Compare group NPD
• Faith V Jones, AGNP-C

  • Nurse Practitioner
  • Valdosta, GA
  • NPI 1952182784

  Dermatology

  Medicare reassignment Care Compare group NPD
• Nina Alice Keown, FNP

  • Family Nurse Practitioner
  • Valdosta, GA
  • NPI 1316299662
  Medicare reassignment Care Compare group NPD
• Abbey Walker Vandermeid, NP

  • Adult Health Nurse Practitioner
  • Valdosta, GA
  • NPI 1801131859
  Medicare reassignment Care Compare group NPD
• Heidi C Gonzalez, FNP-C

  • Family Nurse Practitioner
  • Valdosta, GA
  • NPI 1962393744
  Medicare reassignment NPD
• Barbara Mallory Lane, NP

  • Psychiatry Physician
  • Valdosta, GA
  • NPI 1003699240
  Medicare reassignment
• Barbara Ann Pearce, ANP-C

  • Adult Health Nurse Practitioner
  • Valdosta, GA
  • NPI 1023158763
  NPD
• Arianne E Chavez, MD

  • MOHS-Micrographic Surgery Physician
  • Saint Johns, FL
  • NPI 1972762565

  Dermatology

  NPD
• Luke Auguste Hyder, MD

  • Dermatology Physician
  • Pensacola, FL
  • NPI 1699115014
  NPD
• Armand B Cognetta Jr., M.D.

  • MOHS-Micrographic Surgery Physician
  • Tallahassee, FL
  • NPI 1003922592
  NPD (past)
• David J. Dolson, M.D.

  • Dermatopathology Physician
  • Tallahassee, FL
  • NPI 1164492898
  NPD (past)

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

{
    "created_epoch": "1300320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698278400000",
    "number": "1326347238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4233 CAMELOT CROSSING",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "31602",
            "telephone_number": "229-469-4383",
            "fax_number": "229-469-4584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4233 CAMELOT CROSSING",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "31602",
            "telephone_number": "229-469-4383",
            "fax_number": "229-469-4584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THACKER DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-17",
        "last_updated": "2023-10-26",
        "certification_date": "2023-10-26",
        "status": "A",
        "authorized_official_last_name": "PERRY THACKER",
        "authorized_official_first_name": "BETSY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "229-469-4383"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in Valdosta, GA
• Providers in Valdosta, GA by specialty
• Dermatology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 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.