Anita Kanithahalli Shetty, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

068558 Issued in GA

Practice address

835 Cogburn Ave NW
Suite 100
Marietta, GA 30060-1031

Phone

(770) 422-5557

Fax

(770) 422-5456

NPI assigned

Jun 28, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Dermatology

Education

Medical College of Georgia School of Medicine, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dermatology Affiliates LLCGroup PAC ID 5799763975, 14 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

93.2 of 100Reported as group

Promoting interoperability

92

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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

• Dermatology Affiliates, LLC

  • Specialist
  • Atlanta, GA
  • NPI 1730244872
  Medicare reassignment Care Compare group
• Aqua Dermatology of Georgia PC

  dba Goodman Dermatology, Skin Cancer Specialists PC & Aesthetics Center

  • Dermatology Physician
  • Marietta, GA
  • NPI 1114022167
  Medicare reassignment
• Medical Dermatology Specialists,PC

  • Medical Specialty Clinic/Center
  • Sandy Springs, GA
  • NPI 1134544679
  Medicare reassignment
• Daec, Inc

  dba Dermatology Affiliates East Cobb

  • Dermatology Physician
  • Marietta, GA
  • NPI 1962767954
  NPD (past)
• Wesley S Wilborn MD PC

  dba Metro Atlanta Dermatology Group

  • Dermatology Physician
  • Atlanta, GA
  • NPI 1750554978
  NPD (past)

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

{
    "created_epoch": "1182988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1517270400000",
    "number": "1649477035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5730 GLENRIDGE DR STE T100",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303285747",
            "telephone_number": "404-939-9220",
            "fax_number": "470-312-2157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "835 COGBURN AVE NW",
            "address_2": "SUITE 100",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601031",
            "telephone_number": "770-422-5557",
            "fax_number": "770-422-5456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHETTY",
        "first_name": "ANITA",
        "middle_name": "KANITHAHALLI",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-28",
        "last_updated": "2018-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "GA",
            "license": "068558",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEORGIA STATE MEDICAL LICENSE",
            "identifier": "068558",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Benjamin Sherrill, PHARMD
• Craig L Sherrill, R.PH.
• Nancy Earle Sherrington, PT
• Mita Nandan Sheth, DMD
• Ushma Sheth
• Heather Allen Shields, ACCNS-AG, NP-C
• Kristina Shields
• Lauren Ashley Shields, MS, CCC-SLP
• Nicole Shields, AU.D.
• Mesafint Tadesse Shiferaw, MD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2018; 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.