Skin Center of Georgia, PC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

058402 Issued in GA

Legal business name

SKIN CENTER OF GEORGIA, PC

Practice address

1250 Jesse Jewell Pkwy SE
Suite 500
Gainesville, GA 30501-3871

Phone

(770) 535-7546

Fax

(770) 535-7591

NPI assigned

Feb 12, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Misty Caudell, M.D.

Title

President

Phone

(706) 201-6324

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Georgia Skin Center Doing business as

Locations

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

{
    "created_epoch": "1455235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1457568000000",
    "number": "1407215817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1456",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305031456",
            "telephone_number": "770-535-7546",
            "fax_number": "770-535-7591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 JESSE JEWELL PKWY SE",
            "address_2": "SUITE 500",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013871",
            "telephone_number": "770-535-7546",
            "fax_number": "770-535-7591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SKIN CENTER OF GEORGIA, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-12",
        "last_updated": "2016-03-10",
        "status": "A",
        "authorized_official_last_name": "CAUDELL",
        "authorized_official_first_name": "MISTY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "706-201-6324",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "GA",
            "license": "058402",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101343342",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Georgia Skin Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sisu of Georgia, Inc
• Falguni J Siswawala, MD
• George A Sitaras, OTR
• Barath Prashanth Sivasubramanian
• Elizabeth Gail Skarda
• Cassidy May Skinner
• Jeffrey Francis Skorput, PT
• SKP ASC LLC
• Philip T. Slack, MD
• Sleepmed, Inc

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.