Supriya Immaneni, MD

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

95284 Issued in GA

Practice address

308 Coliseum Dr
St 200
Macon, GA 31217-3865

Phone

(478) 742-2180

NPI assigned

Nov 17, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Micrographic Dermatologic Surgery (MDS)Also: Dermatology

Education

Northwestern University Feinberg Medical School, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Georgia Dermatology Specialists PCGroup PAC ID 6800784281, 14 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

74.5 of 100Reported as group

Quality

81.19

Promoting interoperability

99

Improvement activities

40

Cost

34.65

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Georgia Dermatology Specialists PC

  • Specialist
  • Atlanta, GA
  • NPI 1558380527
  Medicare reassignment Care Compare group NPD
• Skin Care Physicians of Georgia, P.C.

  • Dermatology Physician
  • Macon, GA
  • NPI 1346351582
  Medicare reassignment NPD

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

{
    "created_epoch": "1447718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768262400000",
    "number": "1497129399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "308 COLISEUM DR",
            "address_2": "ST 200",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312173865",
            "telephone_number": "478-742-2180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "308 COLISEUM DR",
            "address_2": "ST 200",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312173865",
            "telephone_number": "478-742-2180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IMMANENI",
        "first_name": "SUPRIYA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-11-17",
        "last_updated": "2026-01-13",
        "certification_date": "2026-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "GA",
            "license": "95284",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "GA",
            "license": "95284",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ideal Home Care of Ga
• Koki Ikeda, ATC
• Madalina Ilioaia
• Im-Peds Primary Care LLC
• Image Plastic Surgery Center, Inc
• Izien Iruobe Imoukhuede, MD
• In Home Health LLC
• In Home Health, LLC
• In Stitches PC
• Independent Physical Therapy of Ga LLC

• MOHS-Micrographic Surgery Physician in Macon, GA
• Providers in Macon, GA by specialty
• MOHS-Micrographic Surgery Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2026; 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.
• 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.