Organization Active NPI

Gwinnett Dermatology PC D/B/a Georgia Dermatology Partners

  • Dermatology Physician
  • Snellville, GA
National Provider Identifier
1477596203
Registry record updated Sep 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
GWINNETT DERMATOLOGY PC D/B/A GEORGIA DERMATOLOGY PARTNERS
Practice address
2383 Pate St N
Snellville, GA 30078-3250
Phone
(770) 972-4845
Fax
(770) 972-0358
NPI assigned
Jun 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2019

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

Authorized official

Name
Brenda Rann
Title
Credential
Phone
(770) 972-4845

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207N00000X Primary

Addresses

Primary practice location

2383 Pate St N
Snellville, GA 30078-3250

Mailing address

2383 Pate St N
Snellville, GA 30078-3250
Phone (770) 972-4845

Other identifiers 1

IdentifierTypeStateIssuer
CB2388OtherRAILROAD MCARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040505000294 GA Part B Supplier - Clinic/Group Practice 6002804309 Receives reassigned benefits from 24 practitioners
Practice locations: Atlanta, GA; Braselton, GA; Brookhaven, GA; Loganville, GA; Snellville, GA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D0675407Georgia Dermatology Partners2383 Pate Street, Snellville, GA 30078ComplianceSep 14, 2026

National Provider Directory

National Provider Directory

Locations

1515 River Pl
Ste 300
Braselton, GA 30517
Phone (770) 972-4845

1239 Friendship Rd
Ste 200
Braselton, GA 30517

1239 Friendship Rd
Ste 100
Braselton, GA 30517
Phone (770) 972-4845

3929 Peachtree Rd NE
Ste 300
Brookhaven, GA 30319
Phone (770) 972-4845

400 Brookstone Centre Pkwy
Ste 500
Columbus, GA 31904
Phone (706) 568-2700

117 Lee Byrd Rd
Loganville, GA 30052
Phone (770) 972-4845

15 Riverbend Dr SW
Ste 120
Rome, GA 30161
Phone (706) 234-0094

5555 Peachtree Dunwoody Rd
Ste 281
Sandy Springs, GA 30342
Phone (404) 252-3771

2383 Pate St N
Snellville, GA 30078
Phone (770) 972-4845

Practitioners & affiliated clinicians

Practitioners 55

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 55

NPI Registry JSON

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568937600000",
    "number": "1477596203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2383 PATE ST N",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300783250",
            "telephone_number": "770-972-4845",
            "fax_number": "770-972-0358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2383 PATE ST N",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300783250",
            "telephone_number": "770-972-4845",
            "fax_number": "770-972-0358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GWINNETT DERMATOLOGY PC D/B/A GEORGIA DERMATOLOGY PARTNERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-13",
        "last_updated": "2019-09-20",
        "status": "A",
        "authorized_official_last_name": "RANN",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_title_or_position": "CREDENTIAL",
        "authorized_official_telephone_number": "770-972-4845"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MCARE",
            "identifier": "CB2388",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Snellville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2019; 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.