Active NPI
Richard L Detlefs, M.D.
- Dermatology Physician
- Atlanta, GA
National Provider Identifier
1477530210
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 29438
- Practice address
- 2045 Peachtree Rd NE
Suite 525
Atlanta, GA 30309-1414 - Phone
- (404) 351-7546
- Fax
- (678) 540-0100
- NPI assigned
- Dec 22, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 29438 | GA | Primary |
Addresses
Primary practice location
2045 Peachtree Rd NE
Suite 525
Atlanta, GA 30309-1414
Mailing address
2045 Peachtree Rd NE Ste 200
Atlanta, GA 30309-1497
Phone (404) 351-7546
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29438 | GA | MD | Dermatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135209600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1588204800000",
"number": "1477530210",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2045 PEACHTREE RD NE STE 200",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303091497",
"telephone_number": "404-351-7546",
"fax_number": "678-540-0100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2045 PEACHTREE RD NE",
"address_2": "SUITE 525",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303091414",
"telephone_number": "404-351-7546",
"fax_number": "678-540-0100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DETLEFS",
"first_name": "RICHARD",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-22",
"last_updated": "2020-04-30",
"certification_date": "2020-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "GA",
"license": "29438",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.