NPIMap

Organization Active NPI

Coastal Medical Dermatology

  • Specialist
  • Atlanta, GA
National Provider Identifier
1699553552
Registry record updated Sep 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
COASTAL MEDICAL DERMATOLOGY
Practice address
285 W Wieuca Rd NE
Atlanta, GA 30342-3321
Phone
(215) 439-9519
Fax
(678) 647-6762
NPI assigned
Sep 20, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2023

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

Authorized official

Name
Sandra V DareusNPI 1093592552
Title
Owner
Phone
(215) 439-9519

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

285 W Wieuca Rd NE
Atlanta, GA 30342-3321

Mailing address

45 Boynton Ave SE Unit 1207
Atlanta, GA 30315-1868
Phone (215) 439-9519

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1695168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695168000000",
    "number": "1699553552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 BOYNTON AVE SE UNIT 1207",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303151868",
            "telephone_number": "215-439-9519"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "285 W WIEUCA RD NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303423321",
            "telephone_number": "215-439-9519",
            "fax_number": "678-647-6762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COASTAL MEDICAL DERMATOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-20",
        "last_updated": "2023-09-20",
        "certification_date": "2023-09-20",
        "status": "A",
        "authorized_official_last_name": "DAREUS",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "215-439-9519"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "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 Sep 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.