Shana Boyd Hackworth, PHYSICIAN ASSISTANT

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

004400 Issued in GA

Practice address

111 Marble Mill Rd NW
Marietta Dermatology Associates PA
Marietta, GA 30060-1047

Phone

(770) 422-1013

Fax

(770) 514-5996

NPI assigned

Feb 13, 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

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Marietta Dermatology Associates PAGroup PAC ID 6507850120, 22 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Marietta Dermatology Associates PA

  • Dermatology Physician
  • Marietta, GA
  • NPI 1417007212
  Medicare reassignment Care Compare group
• Knoxville Dermatology Group PC

  • Dermatology Physician
  • Knoxville, TN
  • NPI 1760419014
  NPD (past)

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1277683200000",
    "number": "1710029277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 MARBLE MILL RD NW",
            "address_2": "MARIETTA DERMATOLOGY ASSOCIATES PA",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601047",
            "telephone_number": "770-422-1013",
            "fax_number": "770-514-5996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 MARBLE MILL RD NW",
            "address_2": "MARIETTA DERMATOLOGY ASSOCIATES PA",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300601047",
            "telephone_number": "770-422-1013",
            "fax_number": "770-514-5996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HACKWORTH",
        "first_name": "SHANA",
        "middle_name": "BOYD",
        "name_prefix": "Mrs.",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-13",
        "last_updated": "2010-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "GA",
            "license": "004400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rediet Habtemarkos, M.D.
• David R. Haburchak, MD
• Eddie Hackler III, M.D.
• Edmond F. Hackney, RPH
• Melanie Hackney, PMHNP-BC
• Jeremy Eric Hadibe, DDS
• Charles R Haendel, DPM
• Joseph Vance Haezebrouck, D.C.
• David H. Hafner, M.D.
• Colleen L Hagan

• Medical Physician Assistant in Marietta, GA
• Providers in Marietta, GA by specialty
• Medical Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2010; 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.