Experience Dermatology LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

EXPERIENCE DERMATOLOGY LLC

Practice address

17 Executive Park Dr NE Ste 115
Atlanta, GA 30329-2222

Phone

(404) 737-2333

Fax

(404) 737-2444

NPI assigned

Jun 20, 2024

Organization subpart

No

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

Authorized official

Name

Dr. Zachary Warren Eyre, MD, MBANPI 1568994085

Title

Owner/Physician

Phone

(801) 822-8565

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 2

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

• Zachary Eyre, M.D., MBA

  • Dermatology Physician
  • Atlanta, GA
  • NPI 1568994085
  Medicare reassignment Care Compare group NPD Authorized official
• Sharon Leigh Doering, PA-C

  • Physician Assistant
  • Atlanta, GA
  • NPI 1760459317
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1718841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718841600000",
    "number": "1659115145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 EXECUTIVE PARK DR NE STE 115",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303292222",
            "telephone_number": "404-737-2333",
            "fax_number": "404-737-2444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 EXECUTIVE PARK DR NE STE 115",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303292222",
            "telephone_number": "404-737-2333",
            "fax_number": "404-737-2444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXPERIENCE DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-20",
        "last_updated": "2024-06-20",
        "certification_date": "2024-06-15",
        "status": "A",
        "authorized_official_last_name": "EYRE",
        "authorized_official_first_name": "ZACHARY",
        "authorized_official_middle_name": "WARREN",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "801-822-8565",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD, MBA"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Exhale Private Home Care LLC
• Kelsey Lynn Exline
• Expand Psychotherapy, LLC
• Expansions Inc
• Expect Great Things LLC
• Expert in Mind
• Express at Northside LLC
• Express Food & Pharmacy Investment LLC
• Express Food & Pharmacy LLC
• Express Food & Pharmacy LLC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2024; 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.