NPIMap

Organization Active NPI

Dermatology & Skin Cancer Prevention Center, Inc.

  • Specialist
  • Stockbridge, GA
National Provider Identifier
1710213947
Registry record updated Mar 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
052394 Issued in GA
Legal business name
DERMATOLOGY & SKIN CANCER PREVENTION CENTER, INC.
Practice address
1215 Eagles Landing Parkway
Suite 205
Stockbridge, GA 30281-7280
Phone
(770) 389-9116
Fax
(770) 506-4580
NPI assigned
Oct 22, 2009
Last updated
Mar 23, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2011

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

Authorized official

Name
David S. Bryant, M.D.NPI 1255382701
Title
Owner
Phone
(770) 389-9116

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X 052394 GA Primary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X 005538 GA

Addresses

Primary practice location

1215 Eagles Landing Parkway
Suite 205
Stockbridge, GA 30281-7280

Mailing address

1215 Eagles Landing Parkway
Suite 205
Stockbridge, GA 30281-7280
Phone (770) 389-9116

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100204000349 GA Part B Supplier - Clinic/Group Practice 7113060799 Receives reassigned benefits from 4 practitioners
Practice locations: Stockbridge, GA

National Provider Directory

National Provider Directory

Locations

3275 Market Place Blvd
Cumming, GA 30041

11338 Tara Blvd
Lovejoy, GA 30228

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1256169600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300838400000",
    "number": "1710213947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 EAGLES LANDING PARKWAY",
            "address_2": "SUITE 205",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302817280",
            "telephone_number": "770-389-9116",
            "fax_number": "770-506-4580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 EAGLES LANDING PARKWAY",
            "address_2": "SUITE 205",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302817280",
            "telephone_number": "770-389-9116",
            "fax_number": "770-506-4580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY & SKIN CANCER PREVENTION CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-22",
        "last_updated": "2011-03-23",
        "status": "A",
        "authorized_official_last_name": "BRYANT",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "770-389-9116",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "GA",
            "license": "052394",
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "GA",
            "license": "005538",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockbridge, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2011; 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.