Northeast Georgia Dermatology, PC

Primary specialty

SpecialistTaxonomy code 174400000X

License

033190 Issued in GA

Legal business name

NORTHEAST GEORGIA DERMATOLOGY, PC

Practice address

204 Gainesville Hwy
Blairsville, GA 30512-4512

Phone

(706) 781-1600

Fax

(706) 835-2794

NPI assigned

Jan 31, 2013

Last updated

Jan 31, 2013By 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. Perry J Scallan Sr., M.D. F.A.C.P.NPI 1720130156

Title

Owner

Phone

(706) 781-1600

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

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, and the practitioner matching its NPPES authorized official.

• Perry J Scallan Sr., M.D.F.A.C.P

  • Specialist
  • Blairsville, GA
  • NPI 1720130156
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1359590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359590400000",
    "number": "1437498185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 GAINESVILLE HWY",
            "city": "BLAIRSVILLE",
            "state": "GA",
            "postal_code": "305124512",
            "telephone_number": "706-781-1600",
            "fax_number": "706-835-2794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 GAINESVILLE HWY",
            "city": "BLAIRSVILLE",
            "state": "GA",
            "postal_code": "305124512",
            "telephone_number": "706-781-1600",
            "fax_number": "706-835-2794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST GEORGIA DERMATOLOGY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-31",
        "last_updated": "2013-01-31",
        "status": "A",
        "authorized_official_last_name": "SCALLAN",
        "authorized_official_first_name": "PERRY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "706-781-1600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "M.D. F.A.C.P."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "GA",
            "license": "033190",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2013; 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.