Dermatology Boutique LLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

051138 Issued in GA

Legal business name

DERMATOLOGY BOUTIQUE LLC

Practice address

550 Peachtree St NE Ste 1490
Atlanta, GA 30308-2244

Phone

(404) 523-4223

NPI assigned

Feb 22, 2007

Organization subpart

No

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

Authorized official

Name

Wakitha A. Griffin, MDNPI 1437141728

Title

Owner

Phone

(404) 523-4223

Specialties & licenses 1

Addresses

Other names 1

• INTOWN DERMATOLOGY Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 1

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

• Wakitha A. Griffin, M.D.

  • Specialist
  • Atlanta, GA
  • NPI 1437141728
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667865600000",
    "number": "1699800516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 PEACHTREE ST NE STE 1490",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303082244",
            "telephone_number": "404-523-4223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 PEACHTREE ST NE STE 1490",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303082244",
            "telephone_number": "404-523-4223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY BOUTIQUE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-22",
        "last_updated": "2022-11-08",
        "certification_date": "2022-11-08",
        "status": "A",
        "authorized_official_last_name": "GRIFFIN",
        "authorized_official_first_name": "WAKITHA",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-523-4223",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "GA",
            "license": "051138",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "INTOWN DERMATOLOGY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stephanie Deren
• Terry Derias, MD
• Anna T Deriso, RNC, WHNP
• Dermatology Affiliates, LLC
• Dermatology Associates of Atlanta
• Dermatology Consultants, P.C.
• Dermyne & Dwyer LLC
• Deroad Technology
• Blair Derossett, NNP
• Lauren Derossette, LPC, NCC, CCH

• Specialist in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Specialist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.