ASC of Georgia Dermatologic Surgery

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

ASC OF GEORGIA DERMATOLOGIC SURGERY

Doing business as

ASC of Baucom & Mina Derm Surgery

Practice address

5555 Peachtree Dunwoody Rd Ste 220
Atlanta, GA 30342-1724

Phone

(404) 844-0496

Fax

(404) 844-0499

NPI assigned

Nov 2, 2006

Last updated

Dec 13, 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

Dr. Mark Baucom, M.D.NPI 1831184357

Title

President

Phone

(404) 844-0496

Specialties & licenses 1

Addresses

Other names 1

• ASC of Baucom & Mina Derm Surgery Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Listed as

Georgia Dermatoligi Surgery Centers PCCCN 11C0001265

Medicare certification status

ActiveFrom the Provider of Services file

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Baucom & Mina Derm Surgery, LLC

  • MOHS-Micrographic Surgery Physician
  • Atlanta, GA
  • NPI 1245780980

  Member Of

  NPD member

Locations

Practitioners 2

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.

• Mark Francis Baucom, M.D.

  • MOHS-Micrographic Surgery Physician
  • Atlanta, GA
  • NPI 1831184357
  NPD (past) Authorized official
• Mary Alice Nading Mina, M.D.

  • MOHS-Micrographic Surgery Physician
  • Atlanta, GA
  • NPI 1538329149
  NPD (past)

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

{
    "created_epoch": "1162425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702425600000",
    "number": "1356429765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5555 PEACHTREE DUNWOODY RD STE 220",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421724",
            "telephone_number": "404-844-0496",
            "fax_number": "404-844-0499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5555 PEACHTREE DUNWOODY RD STE 220",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421724",
            "telephone_number": "404-844-0496",
            "fax_number": "404-844-0499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASC OF GEORGIA DERMATOLOGIC SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-02",
        "last_updated": "2023-12-13",
        "certification_date": "2023-12-13",
        "status": "A",
        "authorized_official_last_name": "BAUCOM",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "404-844-0496",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ASC of Baucom & Mina Derm Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Ambulatory Surgical Clinic/Center in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Ambulatory Surgical Clinic/Center 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.
• 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.